Fingerprint Submission - Paper Card Request Form

This is the Fingerprint Submission Process for Paper Card Requests.

Note: To request an ink and paper card, you must first schedule a fieldprint appointment. Your fieldprint confirmation number will be required.*
I confirm that I have scheduled my fieldprint appointment.
Enter your reason for a paper card request. If you are submitting your fingerprints electronically, you DO NOT need to fill out this paper card request form. Please enter a reason that will support why you cannot submit your fingerprints electronically. I.e. the location is too far away or the hours are not reasonable.*
Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Phone*
Email*
EMS Certification Number
Social Security Number (Last four digits only)*
Enter last four digits only
Fieldprint Confirmation Number*
EMS Agency License Number*
This is the license number of the EMS Agency that you're requesting to join.
Comments
This field is for validation purposes and should be left unchanged.

Last Updated: December 27, 2019