Do Not Fax Do Not Fax - Vermont Department of Health - healthvermont: Fill out & sign online

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Click ‘Get Form’ to open it in the editor.
Begin by filling in the Course Coordinator and EMS District # fields at the top of the form. Ensure that all names and EMT numbers are accurately entered.
In the Course Logistics section, provide details such as the course location, start and end dates, estimated number of students, and student fee. Indicate whether the fee includes the textbook.
Complete the Textbook section with title, author, and edition information. Also, list any sources of equipment and outline student prerequisites.
Review and sign the Local Commitment and Approval section. Ensure that both the Course Coordinator and District Chairperson sign and date where indicated.
For EMS Office Use Only, leave this section blank as it will be filled out by authorized personnel after submission.

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