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Click ‘Get Form’ to open the ems 1650 application in the editor.
Begin by entering your program name and address in the 'General Program Contact Information' section. Ensure that the organization name matches the certificate.
Fill out the 'Authorizing Official Information' with the details of the person who has signature authority, including their name, telephone number, and email address.
Provide information for the Program Coordinator and Medical Director, including names, contact numbers, and email addresses. This is crucial for maintaining communication.
Complete sections regarding EMS certification levels and instructor details. Make sure to list all instructors who will be utilized in your program along with their certification numbers.
In the final sections, describe your department's overview and ensure you answer all questions regarding facilities and course offerings accurately.
Finally, review all entered information for accuracy before signing as the Authorizing Official. Use our platform’s features to save or print your completed form.

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