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Create New Student Profile

Profile must be created for the person attending the class

Profile Creation tips:
  • Use your (or student) legal name.
  • To receive class confirmations details and receipts, include a valid email. 
  • To receive text communications, opt in on tab two.
  • Add your (or student) address, any official documents will be sent to the one provided.
  • Profiles cannot be shared amongst others in a company, household, etc.  Each student must have their own profile, changing the profile to another student name is prohibited  
  • Learners under the age of 18 are not permitted to enroll in non-youth courses unless otherwise specified in the class description. 
* denotes required information.

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Username: minimum 6 characters
Password: minimum 8 characters, must contain a number and any two of the following three: upper case, lower case, special characters (for example: (){}!@$%^&*)
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 Privacy Policy
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Birthdate

mm/dd/yyyy
Social Security Number

Some professional licensures require SSN example (999999999) do not add only partial SS numbers.
Colleague Number (k no.)

do not use the leading k and number must be 7 digits long example 0000000
Gender
Male
Female
Non-binary
Identity not listed
Prefer not to disclose
Race
Cancel

Primary Address
 
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Secondary Address

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Additional phone
 
 
Receive text communications? *
Text communications number *
Receive text notifications for
Use Ctrl key with mouse click to select or unselect multiple options
Mail preference
May we include you on our mailing lists?
Yes No
E-mail Preference
Yes No
Receive promotions via email
Cancel

If your company is not available in the list, select ** Add Company ** and you will be prompted to add your company's information after submitting this form.
Employer
Company Type
Educational Level
Type 1-Professional License Type
Type 1-Professional License Number

Professional license number for state recertification
Type 1-Professional License Number Expiration Date

mm/dd/yyyy
State that Professional License has been issued
NREMT Registration Number

Applicable to people who are currently certified by the National Registry of Emergency Medical Tech
NREMT Re-Registration Date

mm/dd/yyyy
Type 2-Professional License Type
Type 2-Professional License Number

Professional license number for state recertification
Type 2-Professional License Number Expiration Date

mm/dd/yyyy