New Jersey Department of Health Office of Emergency Medical Services 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the student's name in the designated fields: First, Middle Initial, and Last. Ensure accuracy as this information is crucial for identification.
3. Input the Student EMS ID Number, followed by the complete address including City, County, State, and Zip Code. Double-check these details for correctness.
4. Next, specify the Name of Eligible Volunteer EMS Agency and Course Sponsor. Fill in the Course Start Date and Course End Date accurately to reflect the training schedule.
5. Enter the Course Title and New Jersey Course Approval Number. This information validates the course's legitimacy.
6. In the verification section, ensure that all criteria are met before signing. The Principal Officer must type their name, title, provide contact details, and include a wet signature in blue ink.

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