Fillable This document contains both information and form fields. (Collège Boréal)

Fill Online, Printable, Fillable, Blank This document contains both information and form fields. (Collège Boréal) Form

Use Fill to complete blank online COLLèGE BORéAL pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

This document contains both information and form fields. (Collège Boréal)

On average this form takes 15 minutes to complete

The This document contains both information and form fields. (Collège Boréal) form is 19 pages long and contains:

  • 0 signatures
  • 8 check-boxes
  • 55 other fields

Country of origin: CANADA
File type: PDF

Canada forms for Collège Boréal

BROWSE COLLèGE BORéAL FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
This document contains both information and form fields. To read information, use the Down Arrow from a form field.
Advanced Care Paramedic
Examination
Information and
Application Package
2021
version 1.0
Emergency Health Regulatory and Accountability Branch
Ministry of Health
To all users of this publication:
The information contained in this standard has been carefully compiled and is believed to be accurate at
date of publication.
For further information, please contact:
Em
ergency Health Regulatory and Accountability Branch
Ministry of Health
5700 Yonge Street, 6th Floor
Toronto, ON M2M 4K5
416-327-7900
CertificationExams@ontario.ca
© Queen’s Printer for Ontario, 2020
Document Control
Version
Number
Date of Issue Brief Description of Change
1.0 December 2020 Dates for 2021
This page is intentionally left blank.
Table of Contents
General ........................................................................................................................................... 6
Completing the Application Form ............................................................................................... 6
Session Information ...................................................................................................................... 6
Examination Schedule and Locations ..................................................................................... 6
Applicant Information .................................................................................................................. 6
Training Program Information ..................................................................................................... 7
College or Training Institution................................................................................................ 7
Program Completion Date ...................................................................................................... 7
Examination Component(s) .......................................................................................................... 7
Location .................................................................................................................................. 7
Special Considerations ............................................................................................................ 7
Requirements for Eligibility ......................................................................................................... 7
Signature ....................................................................................................................................... 8
Application Policies ....................................................................................................................... 8
Eligibility ...................................................................................................................................... 8
Qualifications .......................................................................................................................... 8
Number of attempts at the examination .................................................................................. 8
Time elapsed since graduation ................................................................................................ 8
Confirmation of Exam Registration ............................................................................................. 9
Examination Questions ................................................................................................................ 9
Requests for Withdrawals and Refunds ....................................................................................... 9
Examination Results ................................................................................................................... 10
Reporting Changes ..................................................................................................................... 10
Contact ......................................................................................................................................... 11
Advanced Care Paramedic Examination
Information and Application Package
2021
This page has been left intentionally blank.
Emergency Health Regulatory and Accountability Branch, Ontario Ministry of Health
Advanced Care Paramedic Examination Information and Application Package - 2021 6
v1.0
General
Please retain this package for reference purposes. Any questions about the information contained in
this package should be directed to the Manager, Certification and Patient Care Standards (CPCS),
Emergency Health Regulatory and Accountability Branch (EHRAB).
Completing the Application Form
Application forms must be completed fully and be printed clearly in ink.
Session Information
On the Application form check (✓) the examination session of your choice and make note of the
dates that apply to your session.
Examination Schedule and Locations
Session Exam Date
Deadlines for
Submissions
Exam Location*
Winter January 20, 2021 November 27, 2020
London, Niagara, Ottawa,
Sudbury, Toronto
Spring April 14, 2021 February 19, 2021
Summer July 21, 2021 May 28, 2021
Fall October 20, 2021 August 27, 2021
*These locations may be used depending on the number of candidates.
If you are a New Candidate check the appropriate box and continue down to the Applicant
Information section.
If you are a Repeat Candidate check the appropriate box, provide your Advanced Care Paramedic
(ACP) file number and your Advanced Emergency Medical Care Assistant (AEMCA) certificate
numbers where indicated. Where indicated enter the year and month (e.g. 2006/06) of each previous
ACP Examination taken. Your AEMCA number can be found on your AEMCA/EMCA certificate, at
the bottom left hand side. Do not include your EHS ID number.
Applications received after the deadline date will not be accepted.
Applicant Information
Clearly print your name, address and telephone number where indicated. Provide an alternate
telephone number such as a mobile or work number if applicable. Provide your email address to
assist with communication regarding your application and examination information as required.
Emergency Health Regulatory and Accountability Branch, Ontario Ministry of Health
Advanced Care Paramedic Examination Information and Application Package - 2021 7
v1.0
Please note that the name that appears on your correspondence and certificate will be exactly as you
have recorded it on your Application form [your full name, including your middle name(s) and/or
initial(s)].
Training Program Information
College or Training Institution
Print the name of your college or training Institution. Please include your campus name if applicable.
Program Completion Date
Enter the date that you completed or expect to complete all requirements of your ACP program.
Examination Component(s)
Location
Please indicate your first and second examination location choice(s) on the Application form. Please
note that the examination locations used are dependent on the number of candidates that register for
that location. Every effort will be made to accommodate your preference, however please note that
you may not be guaranteed your first choice.
Special Considerations
1. The ACP Examination is available in English and if required, in French. Please indicate if
you require a French version of the examination by checking the box under this section
on the Application form. Applicants requesting a French copy of the examination will
also be provided an English copy.
2. P
lease indicate if you have a special learning need by checking the box under this section
on the Application form. If the request is granted, semi-private accommodations will be
provided, as well as up to 30% additional writing time for the examination. Official
confirmation of the candidate’s special learning need must be current documentation
from their college or training institution’s Special Needs Office or documented in a
current letter from a doctor specializing in learning disabilities. All documentation must
accompany the Application form in order for the applicant’s request to be considered.
CPCS cannot accommodate late requests for special learning needs.
Requirements for Eligibility
1. Please ensure that the registration fee of $50.00 payable to the Minister of Finance by
certified cheque or money order is enclosed with the completed Application form. Fees
must be in Canadian funds.
Cash or personal cheques will not be accepted.
2. Proof of successful completion of an approved ACP program is required for first time
graduates and applicants who have re-graduated from the program. Applicants must
Emergency Health Regulatory and Accountability Branch, Ontario Ministry of Health
Advanced Care Paramedic Examination Information and Application Package - 2021 8
v1.0
ensure that their college or training institution has provided CPCS with an official letter
on letterhead which includes the date and signature of the Program Coordinator
confirming successful program completion. Proof of graduation must be received by
CPCS no later than two weeks prior to the examination date.
The requirement to provide proof of successful completion of an approved ACP program does not
apply to applicants who are within their number of allowable attempts under the Eligibility policy or
applicants who successfully completed the MOH Standard Advanced Care Paramedic Equivalency
Process.
Signature
Review your Application form to ensure that all of the required fields have been completed and all
printed information is legible. Please read, sign and date the Application. Applications must be
submitted to CPCS with an original signature, in ink.
Application Policies
Eligibility
Eligibility to write the ACP Examination is based on the following three conditions:
Qualifications
The candidate must:
• hold Advanced Emergency Medical Care Assistant (AEMCA) certification; and
• m
ust have successfully completed an approved Advanced Care Paramedic training
program offered in Ontario or have successfully completed the MOH Standard Advanced
Care Paramedic Equivalency Process.
Number of attempts at the examination
Eligibility is limited to a maximum of three attempts at the examination. Candidates who have been
unsuccessful after three attempts at the examination would need to re-graduate from an approved
ACP program in order to renew their eligibility. Candidates who have renewed their eligibility are
eligible for three further attempts at the examination within 24 months of re-graduating.
Time elapsed since graduation
Eligibility gained by either completing an ACP program, or by receiving equivalency status, is
limited 24 months. Candidates who have not successfully completed the examination within 24
months of their program completion date would need to re-graduate from an approved ACP program
in order to renew their eligibility. Candidates who have renewed their eligibility are eligible for three
further attempts at the examination within 24 months of re-graduating.
Emergency Health Regulatory and Accountability Branch, Ontario Ministry of Health
Advanced Care Paramedic Examination Information and Application Package - 2021 9
v1.0
Please contact CPCS if you have any questions regarding your eligibility status. Candidates who
completed their first attempt prior to 2019 may be eligible for additional considerations.
Confirmation of Exam Registration
Notification Letters to confirm registration date, time and place of the examination, will be issued to
candidates once CPCS has confirmed the candidate’s eligibility (i.e. receipt of registration fee,
official proof of successful completion of an approved ACP program, etc.). Notification Letters will
be issued to eligible candidates approximately two weeks before the examination date.
If at any point after registering at your examination location on the day of the exam, you cannot
complete the examination, you will be considered withdrawn from the examination and it will be
counted as an attempt at the exam. You may complete the ACP Examination Withdrawal and Refund
Application form to apply for a partial refund.
Examination Questions
Questions on the ACP Examination are based on the ACP Core Medical Directives and the ACP
Auxiliary Medical Directives of the current Advanced Life Support Patient Care Standards and other
paramedic practice standards that are “in force” as of the examination date.
A list of paramedic practice standards and their in force dates can be found at:
http://www.health.gov.on.ca/en/pro/programs/emergency_health/edu/practice_documents.aspx.
Requests for Withdrawals and Refunds
Applicants who are not eligible to write the ACP Examination, or choose to withdraw from the
examination, may complete the ACP Examination Withdrawal and Refund Application form to apply
for a partial refund. Your registration fee cannot be held over to a subsequent examination attempt.
The refund is calculated from the day the withdrawal form is received by CPCS. The refund cheque
will be mailed directly to you.
• A refund of $25.00 is calculated from $50.00 registration fee minus $25.00
a
dministration fee.
• A refund of $15.00 is calculated from $50.00 registration fee minus $25.00
administration fee and $10.00 late fee.
• No refund is issued if the form is received more than 8 days after the examination date.
Emergency Health Regulatory and Accountability Branch, Ontario Ministry of Health
Advanced Care Paramedic Examination Information and Application Package - 2021 10
v1.0
Refund Structure
More than 14 days
before
the Exam Date
Between 14 days before and
8 days after the Exam Date
More than 8 days after
the Exam Date
$25.00 Refund $15.00 Refund No Refund
Winter January 5 January 6 – January 28 January 29
Spring March 30 March 31 – April 22 April 23
Summer July 6 July 7 – July 22 July 23
Fall October 5 October 6 – October 28 October 29
Examination Results
Candidates will be notified by CPCS of their examination results no later than three weeks after
the examination date.
Candidates who are unsuccessful will be sent information to apply for the next examination and a
Feedback Report along with their Results Letter. The Feedback Report identifies question types
where improvement is required.
Please do not call the office for results. In order to treat all candidates fairly, examination results
will not be released over the telephone, in person or to prospective employers.
Reporting Changes
Changes to candidate information (address, telephone number, name changes, etc.) will not be taken
over the phone. Applicants are required to write or email to CPCS and include the following:
1. N
ame
2. O
ld address / old name
3. New address / new name
4. A
CP file number if known (e.g. 00-12345)
5. S
ignature
Emergency Health Regulatory and Accountability Branch, Ontario Ministry of Health
Advanced Care Paramedic Examination Information and Application Package - 2021 11
v1.0
Contact
For more information contact:
Emergency Health Regulatory and Accountability Branch
Ministry of Health
5700 Yonge Street, 6th Floor
Toronto, ON M2M 4K5
Telephone: 416-327-7900
Toll free: 1-800-461-6431
Email: CertificationExams@ontario.ca
Advanced Care Paramedic Examination - 2021
Fields marked with an asterisk (*) are mandatory.
ACP file number
AEMCA file number
Date(s) of previous exams taken:
mm
yyyy
Last Name*
First Name*
Middle Name
Unit No.
Street No.*
Street Name*
PO Box
City/Town*
Province*
Postal Code*
Telephone No.*
( )
Alternate Telephone No.
( )
Email Address*
Name of College or Training Institution*
Campus (if applicable)
Program Completion Date*
yyyy
mm
First Choice*
Second Choice
Signature*
Date (yyyy/mm/dd)*
Ministry of Health
Emergency Health Regulatory and
A
ccountability Branch
ACP Examination
Application
The Emergency Health Regulatory and Accountability Branch is authorized to collect personal information contained on this form by virtue of it being necessary for proper administration
of a lawfully authorized activity, that is, to determine the applicant’s qualifications for approval to undertake the Advanced Care Paramedic (ACP) examination for certification as an ACP.
The examination is authorized under Part III of Ontario Regulation 257/00 made under the Ambulance Act. For information concerning this collection contact: Manager, Certification and
Patient Care Standards, Emergency Health Regulatory and Accountability Branch, Ministry of Health, 5700 Yonge Street, 6th Floor, Toronto ON M2M 4K5, Tel: 416 327-7900
● It is the candidate's responsibility to read and comply with the accompanying Information Package.
● All stipulated requirements must be fulfilled prior to established deadlines in order to ensure eligibility to challenge the examination.
Please check (✓) the examination session of your choice and take note of the corresponding dates that apply to your session:
Session Exam Date Deadlines for submissions Exam Locations
Winter
January 20, 2021 November 27, 2020
London, Niagara, Ottawa, Sudbury, Toronto
Spring
April 14, 2021 February 19, 2021
Summer
July 21, 2021 May 28, 2021
Fall
October 20, 2021 August 27, 2021
New Candidate
Repeat Candidate
0 0 - 0 0 -
Application Information
Address
Training Program Information
Examination Component(s)
Location* Special Considerations
French exam required
Special Learning Needs accommodation request
(
supporting documents must be enclosed)
Requirements for Eligibility
Certified cheque or money order in Canadian funds payable to the Minister of Finance in
the amount of $50.00
Proof of successful completion of an approved Advanced Care Paramedic Training Program.
(
must be sent directly from your college or training institution, see Requirements for
Eligibility for more details)
Completed form must be mailed to:
Ministry of Health
Emergency Health Regulatory and Accountability Branch
Certification and Patient Care Standards
5700 Yonge Street, 6th Floor
Toronto ON M2M 4K5
Signature
A. This is to certify that I have read the application package and agree to comply with the policies as described.
B. This is to certify that the information on this form is true, correct and complete to the best of my knowledge.
C. I hereby permit Emergency Health Regulatory and Accountability Branch, Ministry of Health, and my Training Institution to exchange information pertaining to
t
he ACP examination process. The information will be kept confidential and is for internal use of the Training Institution only.
✓
● Please print clearly and in ink.
*
Ministry of Health
Emergency Health Regulatory and
Accountability Branch
The Emergency Health Regulatory and Accountability Branch is authorized to collect personal information contained on this form by virtue of it being necessary for proper administration
of a lawfully authorized activity, that is, to determine the applicant’s qualifications for approval to undertake the Advanced Care Paramedic (ACP) examination for certification as an
ACP. The examination is authorized under Part III of Ontario Regulation 257/00 made under the Ambulance Act. For information concerning this collection contact: Manager,
Certification and Patient Care Standards, Emergency Health Regulatory and Accountability Branch, Ministry of Health, 5700 Yonge Street, 6th Floor, Toronto ON M2M 4K5, Tel: 416
327-7900
ACP File Number
Please print clearly in ink. Fields marked with an asterisk (*) are mandatory.
Last Name*
First Name*
Middle Name
Unit No.
Street No.*
Street Name*
PO Box
City/Town*
Province*
Postal Code*
Telephone No.*
( )
Alternate Telephone No.
( )
Email Address*
Name of College or Training Institution*
Campus (if applicable)
Signature*
Date (yyyy/mm/dd)*
*
Advanced Care Paramedic Examination - 2021
ACP Examination
Withdrawal and Refund Application
Completed form must be mailed to:
Ministry of Health
Emergency Health Regulatory and Accountability Branch
Certification and Patient Care Standards
5700 Yonge Street, 6th Floor
Toronto ON M2M 4K5
CertificationExams@ontario.ca
0 0 -
Application Information
Address
Reason for Withdrawal
did not graduate from program
other
Refund Structure
More than 14 days before
the E
xam Date
Between 14 days before and
8 days after the Exam Date
More than 8 days after
the Exam Date
$25.00 Refund $15.00 Refund No Refund
Winter
January 5 January 6 – January 28 January 29
Sp
ring
March 30 March 31 – April 22 April 23
S
ummer
July 6 July 7 – July 22 July 23
F
all
October 5 October 6 – October 28 October 29
This page has been left intentionally blank.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

This document contains both information and form fields. (Collge Boral)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 12 December 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document