Exam InformationPlease refer to the ALS exams section of our website to see a current list of ALS exams.Exam Date Requested* MM slash DD slash YYYY Location *Select oneNew England EMS InstituteNH CPRLevel*AEMTParamedicExam Attempt*InitalRetestPrevious Test Date MM slash DD slash YYYY Previous Test Location Candidate InformationLegal Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Cellphone*Email* Date of Birth* MM slash DD slash YYYY Current CertificationsCurrent NREMT Certification:* Yes No NREMT #: Expiration Date MM slash DD slash YYYY If you do not have National Registry certification, do you hold a current State certification: Yes No State Certification held in: Level of Certification: Certification #: Expiration Date: MM slash DD slash YYYY A copy of you current out-of-state certification is required, please upload a copy:Max. file size: 256 MB.Course InformationCourse #: Course Instructor: Course Completion Date* MM slash DD slash YYYY Course Location: For non-New Hampshire training programs please include a copy of a letter or certifcate of completion from the State authorizing the EMS training program. Please upload a copy here:Max. file size: 256 MB.AFFIRMATION - I understand and agree to have the Division send my application information directly to the appropriate testing agency. This information sent to the testing agency shall only be used for registration purposes.* I Understand I DO NOT Understand