Licensure

☐ Current (Unrestricted)

   ☐ National Registry of EMTs
   ☐ State/Province EMS Provider

OR (MPO and FACPE only):

   ☐ Previous Unrestricted State EMS Provider or National Registry of EMTs for at least 5 years

Level

☐ EMT ☐ AEMT ☐ Paramedic ☐ Other: _________________________________

☐

Qualifying Education General (Please click here for Education Requirements)
(All hours must be completed within the last 10 years)

☐ SPO – 80 Hours of ACPE Approved EMS Management Education
☐ MPO – 100 Hours of ACPE Approved EMS Management Education
☐ FACPE – 120 Hours of ACPE Approved EMS Management Education 

(If short, indicate how many hours are still needed: _____ Hours)

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EMS Management Experience

☐ SPO – minimum of 2 years EMS Supervisory/ Practitioner experience
☐ MPO – minimum of 2 years EMS Supervisory/ Management experience
☐ FACPE – minimum of 5 years EMS Management experience

☐

Professional References

☐ SPO – 2 Letters
☐ MPO – 3 Letters
☐ FACPE – 3 Letters

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Professional Resume

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Application Fee - $90 (All levels)
*Application will not be reviewed until this payment is processed. 

☐

Portfolio Submission

☐ FACPE only – Commission approved presentation, publication or research paper 

Click here for Portfolio Rubric

☐

Credentialing Payment 

☐ SPO - NEMSMA Member Exam Price - $105 / Non-Member Exam Price - $155
☐ MPO - NEMSMA Member Exam Price - $235 / Non-Member Exam Price - $335
☐ FACPE - NEMSMA Member Exam Price - $385