westchestergov.com

EMS Registration Form



This is a request to register form. Upon completing and submitting the form, you'll receive an automated acknowledgement. Review the form to be sure your selections are correct and print a copy for your records. Your enrollment status will be sent in a separate e-mail.

NOTE:  Westchester DES reserves the right to cancel classes as necessary and at any time.

An asterisk indicates required information.

If your agency is not in the drop down menu below, send an e-mail to emsedu@westchestergov.com to request to have it added.

If other was selected in Agency drop-down menu above, enter the agency name.
(include area code)

Some courses have class-size restrictions. You will be notified of your enrollment status in a separate e-mail. In the event you are "wait listed," notification of additional availability will be made by e-mail only.

For each student, we require either a phone number or e-mail address - or both - in order to contact them in the event of a class cancellation.
Enter course number from Current Classes page.
Enter course name from Current Classes page. If course description is long, use the first few descriptive words. Be sure to enter the correct course number.
Enter course number from Current Classes page.
Enter course name from Current Classes page. If course description is long, use the first few descriptive words. Be sure to enter the correct course number.
Enter course number from Current Classes page.
Enter course name from Current Classes page. If course description is long, use the first few descriptive words. Be sure to enter the correct course number.
Enter course number from Current Classes page.
Enter course name from Current Classes page. If course description is long, use the first few descriptive words. Be sure to enter the correct course number.

Add any additional comments, questions or explanations below:

To submit this form, you must enter the random verification code in the field below.