Muhlenberg College EMS

Apply for Membership

First Name:

Last Name:

Berg ID:

Class Year:

Campus Address:

Campus Mailbox

School Email (including

Cell Phone:

EMT Number:

EMT State:

EMT Expiration:

CPR Expiration:

Please list two personal references whom you have known for at least a year. These might be teachers, bosses, officers of other EMS organizations, etc.

NameRelationshipPhone Number


Are you a member of any other EMS organization? If so, please list your experience:

Have you been convicted of any crimes? If so, please explain. If not, simply write "No":

Do you consent to a driving and criminal records check?

What other activities, if any, are you involved in on campus?

Why do you want to join Muhlenberg College EMS?

Please list any other certifications or qualifications you may have (CPR instructor, EVOC, etc):

Additional Comments:


The next phase of the application is an interview with our Closed Executive board.

Please select an interview time:

Put it on your calendar now!

Our interview will take place at Campus Safety, located on the 1st floor of Prosser.

Please arrive a few minutes before your interview time and wait on the couches.

One of our members will come out and greet you from there and bring you into our interview room.

Do not hesitate to reach out if you have any questions in the interim.