Psychomotor Eligibility to Test Application

BLS Psychomotor Eligibility to Test Form

Exam Dates Available
Please select an exam date listed in the drop down box.
Exam Attempt*
Level BLS*
Exam Attempt #*
Previous Test Date
MM slash DD slash YYYY
Previous Test Location
Candidate Information
Legal Name*
First Last
NELP or NH EMS License Number*
This number is found in your Respond NH Account. If you do not have a respond NH account Please create one here https://www.respondnh.org/lms/public/portal#/login
Cellphone*
Email (Respond NH)*

Please enter the email address associated with your RespondNH account. If your RespondNH account Email needs to be updated, Please update it here. https://www.respondnh.org/lms/public/portal#/login
Date of Birth*
MM slash DD slash YYYY
Course Information
Course #:
Course Instructor:
Course Completion Date*
MM slash DD slash YYYY

Must be a past course date. Date cannot be in the future.
Course Location:
NREMT Authorization to Test Letter Yes/No (Non-NH Students or Re-entry)*
You should have received an Authorization to Test Letter from NREMT. Please Upload ATT letter Below. If you took a course outside of New Hampshire or are a Re-entry you will need to upload.
ATT Letter (Non-NH Students or Re-entry)
Max. file size: 256 MB.
AFFIRMATION – I understand that by submitting this form I am not registered for the exam until I have received a confirmation email with instructions on how to register for the examination with the exam vendor. I have read and understand the exam instructions and code of conduct statement above.”*
- I Understand
- I DO NOT Understand
If you have any additional questions please contact your Education Specialist.
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