Course Name and Date *
Tuition $
Add'l Course Name and Date
Additional Course Tuition $
Registration Fee (Core Courses Only)
Uniform Shirt HOBET Test (paramedics only)
Textbooks (required for all courses except refreshers and CEs)
Please total all items above and enter amount here $
Student Full Name* DOB* (mm/dd/yyyy)
Address* City*
State* Zip Code* Email Address*
Phone Number* Social Security Number (payment plan students only)
Payment Type
Credit Card Number Expiration Date (mm/yyyy) Security Code
Amount authorized for credit card charges $
Name on card (if different) Address on card (if different)
City State Zip Code
Current EMS License Level How did you hear about us?
Emergency Contact Name*
Emergency Contact Phone Number*
Do you have any special needs that require accommodations under the American with Disabilities Act?
If yes, please explain below
Additonal Information
READ STATEMENT BELOW AND SUBMIT FORM
Payment/Refund Policy – The tuition and fees paid by the applicant/student shall be refunded if the applicant is rejected by M.A.E.S. before enrollment. An application fee of not more than $25.00 may be retained by M.A.E.S. if the application is denied. All tuition and fees paid by the applicant/student shall be refunded if requested in writing 3 business days after signing a contract with M.A.E.S. This policy shall adhere to the refund policies of applicable state, federal and accrediting agencies. After 3 business days have elapsed, the following refund policy will be followed. No refunds shall be given after courses begin. No refunds shall be given for the purchase of uniforms, M.A.E.S. apparel, or any equipment purchased unless those items are defective. If the equipment is found to be defective, said equipment will be replaced. Textbooks shall only be refunded if returned unopened (remain in plastic). All refunds shall be returned within 30 days of receipt of refund request. Seats shall be reserved on a first-come first-serve basis.
The following policy only applies to VA students that qualify and are using VA benefits for tuition payments at MAES.
If a student fails to enter a course or withdraws, or is discontinued from there at any time prior to completion, the amount charged will be an approximate pro-rata portion of the total charges for tuition, registration fee less $10, and other charges that the length of the completed portion of the course bears to its total length.
Student Affirmations: I certify that the information provided in this application is true and complete to the best of my knowledge. I authorize the Michigan Academy of Emergency Services to verify any and all information as may be necessary for admission to the above program. I understand that upon successful completion of the educational program, I will become eligible to participate in the appropriate State of Michigan and/or National Registry of EMT’s examinations (if applicable). For the safety and comfort of all concerned, I acknowledge that I may be removed from any program, without refund, for conduct that violates any law, either criminal or civil, and I shall conduct myself in an appropriate and professional manner at all times.
Background Checks: All students shall have criminal background checks conducted as part of the application process. Fees for the checks are included in the "textbook" fee. Students
Electronic submission of this application indicates understanding and acceptance with the above policies including the criminal background check.
You will receive email confirmation when your invoice is created. Please check your "spam" folder.
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* Required Information
