Nys doh form 4226-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in your personal information. Enter your First Name, Middle Initial, and Last Name in uppercase letters as instructed.
3. Complete your Address, City, State, and ZIP Code. Ensure all fields are filled out accurately to avoid delays.
4. Provide your County and select your Sex. Then, enter your Social Security Number and Participating Agency details along with the DOH Agency Code.
5. Indicate your EMT/AEMT Number and check the appropriate certification level you are applying for.
6. Fill in the Expiration Date of your EMT/AEMT certification and provide contact numbers: Home Phone, Work Phone, and Cell Phone.
7. Read the Personal Affirmation section carefully. If applicable, affirm that you have no criminal convictions before signing.
8. Finally, sign and date the form at the bottom to confirm your understanding of the program requirements.

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