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Acknowledgment of Essential Functions-Paramedic*

Without reasonable accommodations

With reasonable accommodations (ADA requirements, learning disability needs, etc.) Attach documentation of the need for accommodations to the application

By signing below, I acknowledge that I have read and understand the Essential Functions for the Paramedic Student. I believe to the best of my knowledge that I have the ability to learn and perform the Essential Functions: (Please check one)

Name (acts as your signature)*

Date (mm/dd/yyyy)*

Which program are you applying for?*

Form UUID Site Name

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