Forms

• PDF [1MB] 
  EMS-Driver/EMT/AEMT/Paramedic Initial/Renewal PDF Fillable for mail-in or counter service Application PDF [1MB] 
• PDF [633KB] 
  Course Medical First Responder Initial-Completion Roster and Instructions PDF [633KB] 
• PDF [234KB] 
  Course Request and Instructor Verification Form PDF [234KB] 
• PDF [115KB] 
  Office of Emergency Planning and Response Course Roster PDF [115KB] 
• PDF [308KB] 
  Verification of Instructor Emergency Driving Classes Guidelines PDF [308KB] 
  This form contains the requirements to be an EMSD Instructor. This should be completed, submitted, and approved on any new EMSD Instructor prior to teaching the class.
• PDF [138KB] 
  EMS Driver Course Roster PDF [138KB] 
  This form is the class roster and should be completed and submitted the day after class is finished.
• PDF [244KB] 
  Paramedic Course Initial-Completion Rosters PDF [244KB] 
  The initial roster form should be completed no later than the second class meeting. The completion roster form should be filled out no later than 5 days after the completion of class.
• PDF [186KB] 
  EMT Course Initial-Completion Rosters PDF [186KB] 
  The initial roster form should be completed no later than the second class meeting. The completion roster form should be filled out no later than 5 days after the completion of class.
• PDF [61KB] 
  Medical First Responder Skill Competency PDF [61KB] 
  This form should be completed on every person being checked off on First Responder Skills and submitted with completion roster.
• PDF [117KB] 
  Course Request Form (MFR, EMT, Paramedic, Driver) PDF [117KB] 
  This form should be completed for any course request and must be submitted no later than 30 days prior to the start of the class.
• PDF [488KB] 
  EMS Out of State Reciprocity Verification Form PDF [488KB] 
  This form should be completed and submitted to the state or states that the applicant has been previously licensed in prior to applying for a Mississippi Registered EMS license.