Course Sponsor Administration

Application Type - Select One


Sponsorship Renewal- Use if you are renewing and submitting a "short" or "long" form renewal. 

Sponsorship Update- Use if you are looking to update contact information, location info, or any type of sponsor information. 

SOD/POC Submission- Use if you need to submit a statement of deficiency/plan of correction response. 

New Sponsorship | Final Submission- Use if you are submitting your final application for a new course sponsorship. Use only if you have contacted Division staff, submitted your Letter of Intent, and have already met with BEMS staff. This is your final submission.

Sponsorship Update | Final Submission- Use if you are submitting your final application for an upgrade to your sponsorship. Use only if you have submitted your Letter of Intent and have already met with Division staff. This is your final submission.

Type of Sponsorship
Sponsorships approved to provide CLI and CIU courses.
Select all that apply. 

Renewals

Sponsor | Key Demographics

Sponsor Address

All Sponsors

List of projected courses for one year. Include course type, anticipated start date (month and year) and EOC (month and year), and anticipated location of course
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A full summary of revenue and expenditures regarding state funds for the last five years. 
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Verification of Medical Director review and approval of all examinations and course curriculum. 
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All policies and procedures developed in compliance of NYS Regulation 800.20(c)(13). 

SEND ONLY THE POLICY REQUESTED. 

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List of Instructors that includes instructor certification status, instructor certification expiration, state provider number and expiration date.
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All functional job descriptions for each role (CIC, Sponsor Administrator, Liaison, Lab Staff, Coordinators, Medical Director, etc.)
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Do you have any personnel changes?
Sponsor Administrator Info
Liaison Info
Medical Director Info
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Upload requirements

Advanced and Paramedic Sponsorships

All policies and procedures relating to regulation 800.11- EMT Certification throughout Advanced Course 
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List of clinical sites used and date of last update for agreement on file.
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List of field internship sites used and date of last update for agreement on file. 
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Paramedic Sponsor Renewal

Attach your most recent letter providing evidence of accreditation or Letter of Review. Additionally, if you had an onsite in the last two years and received your executive summary, please attach that as well. 
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Abstract of qualifications, CV/resume, and formal job description. 
Upload requirements

Data Collection Questions

What digital tools do you use to help manage your sponsorship and students, if any? Be as descriptive as you can. Was it created in-house or did you purchase it? If purchased, from whom? 
Describe the process in which preceptors for your students are trained in their roles and how this is verified by the sponsorship. 
Item Writing
Upload the current rates that you pay your CICs, CLIs, and other faculty of the sponsorship. 
Upload requirements
How would you improve EMS education in your area and the state? 

Sponsor Updates

Information To Be Updated
Updated Sponsor Information
Sponsor Administrator
Sponsor Liaison/Deputy Administrator
Sponsor Medical Director
CEO/Executive Officer of Organization/Corporation/Municipality
Paramedic Program Director
REQUIRED FOR PARAMEDIC SPONSORSHIPS 
If you are updating more than one position, have a signature form for each position. You can merge them into one pdf and upload as one file. 
Upload requirements
Upload requirements

SOD/POC Submission

You may submit multiple signed documents. 
Upload requirements

Sponsorship Application

Status message

If you are looking to submit an application for a new course sponsorship or an upgrade, read the following:

If you have not submitted a letter of intent and met with Division staff about this application, do not proceed any further. Please email us at ems.coursesponsor@health.ny.gov.  

This application is for final submission only. 

Upgrade

You must upload the following items: 

  1. Course Policies and Procedures for each level upgrade is requested.
  2. A list of certified instructors for the upgrade with proper credentials. Include their provider and instructor numbers, along with their expirations dates.
  3. The Medical Director's CV and abstract.
  4. Inventory of all equipment for the upgrade. Identify if the necessary items have been purchased, on order, or pending approval.
  5. Personnel policies to address upgrade.
  6. List of all Locations, including physical addresses, where classes will be conducted over the next year.
Upload requirements

In this section, you must upload the following: 

  1. 800.11 Policy and Procedure
  2. Clinical Experience Policies
  3. Field Experience Policies 
Upload requirements

This section is for original paramedic upgrades only. You will upload the following:

  1. Program Director Qualifications
  2. Learning Resources 
Upload requirements

You must upload the following: 

  1. Course policies and procedures
  2. Policies and plans on how regional faculty will be engaged for course offerings.
  3. Plans on how regional instructors will be supported and developed.
  4. Personnel policies
  5. List of potential courses and locations for the next year. 
Upload requirements

New Sponsor

Organization's Information

Type of Certification Courses Requested
Original, Refresher, and CME
Original, Refresher, and CME
Original, Refresher, and CME
CLI and CIU Courses
Main Office
Either the general website or the website you will use as a course sponsor. 
Please upload a copy of your Federal ID Certificate. 
Upload requirements
List all counties that you are primarily interested in running programs in. 

Course Files

Course Files Location
Please identify the location of where your Course Files are kept. 
Describe how electronic files are being kept. 

File Uploads

In this section, you will upload the following files: 

  • Copies of course policies and procedures for each level you are applying for. 
  • Equipment and supplies inventory.
  • Course locations and proposed course schedule. 
  • Curriculum review verification.

Upload requirements

In this section you will upload the following documents: 

  • Student Clinical Experience
    • Clinical Sites
    • Affiliation Agreements
    • Objectives and Policies 
    • Preceptor Policies and Selection Process
    • Evaluation Instruments 
    • Preceptor Orientation Materials
  • Field Internship Experience
    • Internship Sites
    • Affiliation Agreements 
    • Objectives and Policies 
    • Preceptor Policies and Selection Process
    • Evaluation Instruments 
    • Preceptor Orientation Materials 

Upload requirements

In this section you will upload the following files: 

  • Program Director CV and required credentials
  • CoAEMSP Accreditation Documentation 
  • Additional Learning Resources for Students 

Upload requirements

Personnel

Personnel Contact Information

Sponsor Administrator
Sponsor Liaison
Sponsor Medical Director
CEO/Executive Officer of Organization/Corporation/Municipality
Paramedic Program Director
REQUIRED FOR PARAMEDIC SPONSORSHIPS 

Documents provided must included the following:

  • List of Instructors
  • Faculty Job Descriptions
  • Personnel Policies
  • Medical Director Info
  • Signature Form
Upload requirements

Submission Signature

Name of Person Submitting
Only the administrator or liaison may submit in this portal. 

I certify that all of the information contained in this application is true and correct and that the signature below is mine as applicant. I further understand that offering or providing false information on this document may constitute action against any sponsorship which may include statement of deficiency or another Department action.

I certify, that I am the duly authorized representative of the sponsorship and I completed this application. 

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