EMS Program Staff
Program Coordinator: Kris Siewert SiewertK@lanecc.edu
Clinical Coordinator: Darrek Mullins MullinsD@lanecc.edu
Administrative Program Support: Marleena Pearson PearsonM@lanecc.edu
Division Dean: Cory Miner MinerJC@lanecc.edu
If you have been asked to work for Lane’s EMS Program as an Independent Contractor for exams or as instructional support, please print and fill out the W-9 Form below. Then complete the EMS Program Instruction Invoice form so that we can gather your contact information (mailing address for sending a check) and details on the service you provided.
If you have a Gmail account, you will be able to attach the W-9 when you complete the Google Form Invoice. If you do not have a Gmail account, you will need to attach it to an email to EMS@lanecc.edu
Vendor ACH Form (Direct Deposit)
Volunteer Waiver of Liability Form (Only for Patients and Runners)
Independent Contractors: Special Events
This is for anyone working to provide first aid/BLS to an event such as marathon, baseball game, football game, graduation, concert or any other even that is NOT part of a class instruction or evaluation.
Independent Contractors: Corvallis Trainings
This is for anyone working on an EMT or AEMT/EMTI training in Corvallis coordinated by Jason Dennis.
EMS Corvallis Instruction or Evaluation Invoice
Independent Contractors: Eugene Trainings
This is for anyone working on an EMT, WEMT, AEMT/EMTI, or Paramedic training in Eugene (program instruction or evaluation on exams, not first aid at events)