The following page contains links to all public forms for the Division of Accreditation, Certification & Education. Select a link below to jump straight to that group of forms:
- Accreditation Forms
- Continuing Education & Certification
- EMT Student Minimum Competencies
- Change of Address & Variance/Exemption Applications
- Instructor Forms
Accreditation Forms
Institutional Self Study Documents
Beginning January 1, 2013, the National Registry of EMT’s will require that paramedic candidates testing must have their training program accredited or recognized by National Registry through CoAEMSP accreditation. For more details about the accreditation process, click on the following link: Paramedic Accreditation.
- EMT – Initial Accreditation
- Advanced EMT – Initial Accreditation
- Alternative Site Approval Application
Continuing Education & Certification
All forms are in Adobe PDF format, unless otherwise specified.
- EMS Operations Asynchronous Education
- TR-06 – Course Roster
- TR-43 – NREMT EMT Testing Application
- TR-43A – NREMT AEMT Testing Application
- TR-53 BLS CE Worksheet
- TR-53A – BLS CE Requirements
- TR-63 – FIPS Code Listing
- TR-66A – ALS CE Requirements
- TR-67 ALS CE Worksheet
- TR-68a – Auxiliary Programs Summary for ALS
- TR-69a – Auxiliary Programs Summary for BLS
Webcasting of Continuing Education (CE) Programming
All forms are in Adobe PDF format, unless otherwise specified.
- Handbook for Webcasting of Continuing Education Programming
- TR-74 – Application for Designation as a Webcast Site
- TR-74-Muni–Fire Application for Designation as a Webcast Site (municipal agencies)
- TR-75 Acknowledgement of Policies for Webcasting of CE Programs
EMR & EMT Student Minimum Competencies
All forms are in Adobe PDF format, unless otherwise specified.
Change of Address & Variance/Exemption Applications
All forms are in Adobe PDF format, unless otherwise specified.
- Address Change
Please note, our systems have changed. You are now required to update your address and other pertinent contact information online through the EMS Provider Portal. Click Here to login to the EMS Provider Portal and change your address on-line. - Application for EMS Variance/Exemption for Providers
- Application for EMS Variance/Exemption for Agencies
Instructor Forms
All forms are in Adobe PDF format, unless otherwise specified.
PLEASE NOTE: Word forms may vary on your computer as they are linked to the printer settings on your individual PC. If these forms do not look right or print out incorrectly, please continue to use the PDF versions and complete them by hand.
- TR-05 – Clinical Training Record
- TR-06 – Course Roster
- TR-07 – BLS Student Permission Form
- TR-09 – BLS Student Signatures
- TR-10 – ALS Student Signatures
- TR-11C – Certification Testing – BLS Programs
- TR-12 – Certification Testing – ALS Programs
- TR-13 – Pearson VUE Testing Procedure
- TR-14A – ALS Functional Job Description
- TR-14B – BLS Functional Job Description
- TR-15B – National Registry Accommodation Policy
- TR-16 – Course Expectations for Successful Completion
- TR-17 – ALS Clinical and Competency Summary
- TR-18 – VILT Program Course Schedule and Registration
- TR-19 – Custom CE Program Outline
- TR-30 – Training Program / Instructor Complaint Form
- TR-31 – ALS Coordinator Application
- TR-35 – Prerequisites for EMS Training Program, Criminal History and Standards of Conduct
- TR-46 – BLS Category 1 Individualized CE Program Worksheet
- TR-47 – ALS Category 1 Individualized CE Program Worksheet
- TR-48 – BLS/ALS Category 2 Individualized CE Program Worksheet
- TR-49 – Instructor/Course Evaluation Form
- TR-62 – Data Request Form – NEW PROCESS: Complete the TR-62 and then submit your FOIA request and the completed form to the Virginia Department of Health through the following website: https://vdh.nextrequest.com/
- TR-63 – FIPS Code Listing
- TR-100 – Request to Allow Out-of-state EMS Providers Scholarship Access