Application for Instructor Certification
Application for Instructor Certification
NOTE: Candidates for instructor courses must qualify prior to the course. Applications (DOH 2260) must be submitted to EMSTAR, 1058 W Church St., Elmira NY 14905, at least 30 days prior to the course date. You can download the application forms and policies from links on this page, or contact staff for an instructor packet.
Print the Department of Health application form, DOH2260 (PDF file). Complete Sections A, B, C and D on the first page, and Section E on the second page.
Certified Lab Instructor
Entry Requirements
- Complete an Application DOH2260
- Hold current certification as a NYS EMT or Advanced EMT
- Written DOH EMS exam within the past three years and scored at least 85%
- Currently active and providing pre-hospital care with an EMS agency and have a minimum of one year of clinical experience within the last three years.
- Letter of recommendation from a Course Sponsor
- Successfully complete the pre-screening examination
Send the completed, signed form to EMSTAR at 1058 West Church Street, Elmira NY 14905, with the following documents:
- Copy of your current EMT/AEMT Card
- Letter from your agency chief or captain, verifying that you have at least one year of prehospital clinical experience within the last three years
- A letter of recommendation from a course sponsor.
Upon completion of the classroom portion of the CLI course, you will need to serve a teaching internship per DOH Policy 08-05 and DOH Policy 04-04, and complete the forms listed on page 2 of DOH2260. Your course sponsor will request the letter of recommendation from the Regional Training Committee.
Certified Instructor Coordinator
Entrance Requirements
- Completed application DOH2260
- Current NYS EMT & CLI certification
- Written EMS exam within last 3 years, with score of at least 85%
- Currently providing pre-hospital care with minimum two years clinical experience within last three years
- Letter of recommendation from a Course Sponsor
Send the completed, signed form to EMSTAR at 1058 West Church Street, Elmira NY 14905, with the folowing documents:
- Copy of your current EMT/AEMT Card & CLI certification
- Letter from your agency chief or captain, verifying that you have at least two years of prehospital clinical experience within the last three years
- A letter of recommendation from a course sponsor.
Upon completion of the classroom portion of the CLI course, you will need to serve a teaching internship per DOH Policy 08-05 and DOH Policy 04-04, and complete the forms listed on page 2 of DOH2260. Your course sponsor will request the letter of recommendation from the Regional Training Committee.