Blanket Approval Number Notification

*Required information.

This is a security field. If you want this form being sent leave the following email field blank:

Course Location Name * Characters left:
Approval Number *
Date of Course (see comment field if more than 1 date) *
Start & End Time of Course *		Characters left:
Course Location Address * Characters left:

Applicant's Full Name *
Email Address *
Course Title *
Comments (may also add additional dates/times here if location is the same) Characters left:

¹ OEMS Memo: EMS Continuing Education and Refresher Course Monitoring; Blanket Approvals Date/Time/Location Notification.

105 CMR 170.960(F) Prior to receipt of Department approval for a training program pursuant to 105 CMR 170.960(A), no nonaccredited training provider shall:

Advertise such a training program as approved by the Department
Accept applications from prospective students
Conduct any classes for such a training program

Please send me a confirmation.

	Contact Us Phone: 508-854-0111 Fax: 508-853-3672
	Send us a message
	Visit us: 361 Holden Street Holden,MA 01520