Fire and EMS Training Sign up for Firefighter I *Is your department/employer paying for this training? OR Do you hold a rank or position within a Fire/EMS department, and perform duties or responsibilities under the authority of that department? Yes No Student Information *First Name *Middle Name or Initial *Last Name Previous Last Name *Cell Phone Number *Street Address Apt or Unit # *City *State *Zip Code *High School Attended *Year Graduated High School Year20252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922 *Email Address Student ID (if known) Are you currently enrolled in any of the following WCTC Fire/EMS Programs? Select an option Fire Protection Technician Fire Medic Paramedic No *Date of Birth Month Month123456789101112 Day Day12345678910111213141516171819202122232425262728293031 Year Year1922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006 *Gender Male Female *Ethnicity American Indian or Alaskan Native Asian Cambodian Laotian Vietnamese Black Hispanic White Native Hawaiian or Pacific Islander *Highest Grade Completed Above 12th grade 12th grade 11th grade 10th grade 9th grade 8th grade Foreign country educated *Highest Credential Received No credential (no GED or higher) Currently in high school GED HSED High school diploma Some college Short-term diploma 1 year diploma 2 year diploma (including apprenticeship) Associate degree Baccalaureate More than baccalaureate *Work Status at Enrollment Employed full-time Employed part-time Under-employed Unemployed seeking employment Not in labor market Dislocated worker *Do you have a physical or learning limitation? Yes No *Are you a single parent with custodial children under 18 years old? Yes No *Have you ever lost family support, are unemployed and re-entering the labor force? Yes No *Are you receiving Pell, WIA, DVR or W-2 assistance, or is your income below poverty level? Yes No *Is your grade point average (GPA) at or below 1.5? Yes No *Billing Option Bill to Fire Department/Employer Bill to Student Bill to Start College Now Program (Learn More) By checking this box, you acknowledge that you are responsible for the tuition and fees associated with this course being billed to either yourself, your employer or the Start College Now Program. It is your responsibility to drop this course if you cannot attend. To drop this course, call the WCTC Enrollment Center at 262-691-5578. Depending on the drop date, you may still be responsible for tuition and fees. Please review our Tuition Refund Policy for full details.