Critical Care Course Screening Form

All applications will be screened and processed before admittance into the class. You will receive a letter of the decision within five business days after a fully completed application is submitted. You will then receive instructions on completing your registration with A-B Tech for class.

Current Demographics
Required Credential Information
Applicant Acknowledgement of 100% Attendance Requirement
Complete

Required fields are marked with an asterisk '*'.

First *

Middle Initial *

Last *

Date of Birth: *

Address *

City/Town *

State/Province *

ZIP/Postal Code *

Address

City/Town

State/Province

ZIP/Postal Code

Email Address: *

Phone:

Mobile:

County Residence: *

Employment Status: *

Employed

Unemployed

Highest Education Level *

Provider Name:

(Employer or Healthcare Affiliation)

Are you currently affiliated with an EMS provider in the State of North Carolina? *

Yes

(This is not a requirement to attend courses, it is asked for fee exemption determination)

Critical Care Course Screening Form

Events

Asheville-Buncombe
Technical Community College

A-B Tech Asheville Campus

A-B Tech Enka

A-B Tech Madison

A-B Tech Woodfin