Request for Licence Extension

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For EMA's to request, prior to the date that their current licence expires, for a licence extension of up to 60 days in order to complete the necessary requirements for renewal.

The Board may, prior to the date that an EMA’s licence expires, extend the EMA’s licence for a period not longer than 60 days, if satisfied that special circumstances exist such that the EMA will be unable, before the licence expires, to complete any requirement necessary for the renewal of the EMA’s licence.

Instructions: All extension requests should be received by EMA Licensing a minimum of two weeks prior to expiry.

To be completed by an individual EMA or Organization/Agency Representative

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Licence Expiry Date Missing or incorrect value
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Expected Date to Complete Licence Renewal Requirements Missing or incorrect value
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Personal information on this form is collected by the EMA Licensing Board under the authority of the Freedom of Information and Protection of Privacy Act Section 26(c) Emergency and Health Services Act (section 6) and the Emergency Medical Assistant Regulation (sections 2, 3, 4, 9.2, 10 and 26). This information will be used to issue an EMA licence and maintain a permanent register of licensed EMA's. If you have any questions about the collection of this information contact our office at PO Box 9625 Stn Prov Govt, Victoria B.C., V8W 9P1, phone 250 952-1211. This information is protected from unauthorized use and disclosure in accordance with the Freedom of Information and Protection of Privacy Act and may be disclosed only in accordance with that Act.
HLTH 3734  Rev. 2023/01/17
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