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Health
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EMA Licensing

Request for Licence Extension

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Request for Licence Extension

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

EMA Licence NumberMissing or incorrect value

Licence Expiry Date

Missing or incorrect value

Last NameMissing or incorrect value

First Name(s) (full legal name)Missing or incorrect value

Email Address

Missing or incorrect value

Expected Date to Complete Licence Renewal Requirements

Missing or incorrect value

What is the reason for not being able to complete the relicensing requirements prior to licence expiry?

Missing or incorrect value

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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The information on this form is collected under the authority of Sections 26(c) and 27(1)(c) of the Freedom of Information and Protection of Privacy Act to help us assess and respond to your enquiry. Questions about the collection of information can be directed to the Manager of Corporate Web, Government Digital Experience Division.

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