MONROE COMMUNITY COLLEGE
PUBLIC SAFETY TRAINING FACILITY
1190 SCOTTSVILLE ROAD
ROCHESTER, NEW YORK 14624
EMERGENCY MEDICAL SERVICES TRAINING
Name: ________________________________________ Soc. Sec. #: ________________________
City: __________________________________ State: ________________ Zip: ________________
Home Phone: ___________________________ Work Phone: ______________________________
Birth Date: _______________________________
Course Name: ___________________________________________________________
Course Location: ________________________________________________________
Course Start Date: _________________
Agency Affiliation: _______________________________________________________
Tuition support from
NYS/EMS can only be provided for active members of EMS agencies which have a
PCR agency code and participate in the PCR system.
Students who are not affiliated with an EMS agency by the start date of the class are NOT eligible for tuition support from NYS/EMS.
Tuition support will only be provided for students who pass the State (re) certification exam when taken on the scheduled test date for the course which he/she is registered. A student who fails or does not test on the original scheduled date will receive a tuition bill issued by the MCC Bursarís Office and is obligated to pay the tuition. A reimbursement from the Bursarís Office will be issued when (re)certification is obtained within one year of the original test date.
For a reservation, complete and return this form by fax, (585-279-4150), or mail (above address, Attn: Karen Wilson). For more information, call 585-279-4011.