Community Paramedicine Certification Program Form

Please complete the following form for the Community Paramedicine Certification program.

Participant Information

First Name:

Last Name:

Email:

Phone Number:

Participant's Program Information

Course Number:

(Please note: A sample course number would be CP0828, CP1030, etc.)

Florida Paramedic License Number:

(Please note: Florida Paramedic License Number information is used to determine eligiblity for the DoH scholarship.)

County of Employment:

(Please note: County of Employment information is used to support the outcome requirements of the DoH grant.)

This training is being provided to support the Florida Department of Health’s efforts to expand the availability and accessibility to community paramedicine under the grant activities of the Centers for Disease Control and Prevention (CDC) National Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk and Underserved, Including Racial and Ethnic Minority Populations and Rural Communities.

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