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Please note that an application fee only extends an initial license to the next renewal date. Initial licenses do vary in duration. It is the responsibility of all licensees to renew their license before expiration. Failure to renew shall result in automatic forfeiture or suspension of the license by statute. Licenses which have forfeited are not automatically entitled to renew.

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Advanced Life Support Program Approval Application

Please complete the below form to request approval of an advanced level ALS program. You will be contacted by email if additional information is required and once approved you will receive a letter from the Board office.

This application is written based on SDCL: 36-4B-10 and Administrative Rule: 20:61:01:07.

 

Select the level of course you are requesting approval for.
List the names of the physicians on the instructor's staff. There must be no less than three physicians on staff and at least one must be experienced in pre-hospital emergency care. 36-4B-1. Definition of terms. Terms used in this chapter mean: (22) "Prehospital care," those emergency medical services rendered to emergency patients in an out-of-hospital setting, administered for analytic, stabilizing, or preventive purposes, precedent to and during transportation of such patients to emergency treatment facilities.
Upload a document that includes the name and location of all Paramedics supervising the field internship portion of training.
Upload a document that includes all instructor names, subjects, time and place of instruction.