SWORBHP College Request for Training: Student Certification

THIS FORM IS TO BE COMPLETED BY A COLLEGE.

If you are from a Paramedic Service and wish to request training, please complete the following form:
https://webforms.lhsc.on.ca/form/sworbhp-service-request-for-trai

Please note, the Student/College will be required to submit payment prior to training via cheque to LHSC as per the following:
PCP: $350
ACP: $500

COLLEGE CONTACT INFORMATION
STUDENT PROFILE
First three characters of the college code (ie. FAN) / ‘P’ or ‘A’ to identify PCP or an ACP student (ie. P) / Last 4 digits of the Student number (ie. 9876)
Has the student been taught all ALS PCS Core Medical Directives
Please check all of the ALS PCS Auxiliary Medical Directives the student has been taught:
STUDENT PROFILE 2
First three characters of the college code (ie. FAN) / ‘P’ or ‘A’ to identify PCP or an ACP student (ie. P) / Last 4 digits of the Student number (ie. 9876)
Has the student been taught all ALS PCS Core Medical Directives_2
Please check all of the ALS PCS Auxiliary Medical Directives the student has been taught
STUDENT PROFILE 3
First three characters of the college code (ie. FAN) / ‘P’ or ‘A’ to identify PCP or an ACP student (ie. P) / Last 4 digits of the Student number (ie. 9876)
Has the student been taught all ALS PCS Core Medical Directives
Please check all of the ALS PCS Auxiliary Medical Directives the student has been taught
STUDENT PROFILE 4
First three characters of the college code (ie. FAN) / ‘P’ or ‘A’ to identify PCP or an ACP student (ie. P) / Last 4 digits of the Student number (ie. 9876)
Has the student been taught all ALS PCS Core Medical Directives
Please check all of the ALS PCS Auxiliary Medical Directives the student has been taught
STUDENT PROFILE 5
First three characters of the college code (ie. FAN) / ‘P’ or ‘A’ to identify PCP or an ACP student (ie. P) / Last 4 digits of the Student number (ie. 9876)
Has the student been taught all ALS PCS Core Medical Directives 5
Please check all of the ALS PCS Auxiliary Medical Directives the student has been taught
STUDENT PROFILE 6
First three characters of the college code (ie. FAN) / ‘P’ or ‘A’ to identify PCP or an ACP student (ie. P) / Last 4 digits of the Student number (ie. 9876)
Has the student been taught all ALS PCS Core Medical Directives 6
Please check all of the ALS PCS Auxiliary Medical Directives the student has been taught
STUDENT PROFILE 7
First three characters of the college code (ie. FAN) / ‘P’ or ‘A’ to identify PCP or an ACP student (ie. P) / Last 4 digits of the Student number (ie. 9876)
Has the student been taught all ALS PCS Core Medical Directives 7
Please check all of the ALS PCS Auxiliary Medical Directives the student has been taught
STUDENT PROFILE
First three characters of the college code (ie. FAN) / ‘P’ or ‘A’ to identify PCP or an ACP student (ie. P) / Last 4 digits of the Student number (ie. 9876)
Has the student been taught all ALS PCS Core Medical Directives 8
Please check all of the ALS PCS Auxiliary Medical Directives the student has been taught
STUDENT PROFILE
First three characters of the college code (ie. FAN) / ‘P’ or ‘A’ to identify PCP or an ACP student (ie. P) / Last 4 digits of the Student number (ie. 9876)
Has the student been taught all ALS PCS Core Medical Directives 9
Please check all of the ALS PCS Auxiliary Medical Directives the student has been taught
STUDENT PROFILE
First three characters of the college code (ie. FAN) / ‘P’ or ‘A’ to identify PCP or an ACP student (ie. P) / Last 4 digits of the Student number (ie. 9876)
Has the student been taught all ALS PCS Core Medical Directives
Please check all of the ALS PCS Auxiliary Medical Directives the student has been taught
COMMENTS