Student Information

Please provide information we can use to coordinate your training and contact you about enrollment
If you are not currently affiliated with an EMS service, enter Not yet affiliated.

Training Request

Submitting this application does not guarantee a seat or funding award.
Would you need travel and lodging assistance?

EMS Background and Rural Service

Current EMS involvement
Include level or write none
State of Alaska EMS number associated with your EMS license

RHTP Rural Service Commitment Acknowledgment

Some grant-funded certification pathways and individual workforce benefits require a five-year rural clinical service commitment in Alaska. Not every course or benefit is subject to this requirement. I understand that: Before I am enrolled in a training program, I will commit to a minimum of five years of qualifying rural clinical service in Alaska as a condition of receiving applicable RHTP-funded benefits. I may be required to provide periodic verification of my qualifying rural service. Failure to fulfill an applicable service commitment may result in consequences under the approved program agreement and governing requirements, including potential repayment or reimbursement of grant-funded benefits, where authorized. I understand that SEREMS will send me the actual commitment form and maintain this signed acknowledgment on file and that it will apply to qualifying RHTP-funded training awards or individual benefits I receive through the Southeast Region EMS Academy during FY27, subject to any additional award-specific agreement or instructions. The applicability and terms of any service obligation will be confirmed when a personal award is made. A separate agreement will be required.
Acknowledgment
By typing your name and submitting, you acknowledge the above information. Confirm that electronic acknowledgments are acceptable under SEREMS policy before publishing.
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