MICN - Online applications NOT available for Initial MICN's

Applications submitted during the last seven (7) calendar days of the month may be delayed due to Agency workflow.

Download the MICN Application form (below) and complete all steps required to become authorized as an MICN in the counties of Amador, Calaveras, Mariposa, and Stanislaus. 

• Minimum one (1) year experience as an R.N. and six months experience in critical care or emergency department nursing.
• Completed and signed MICN  pdf application (288 KB)
• MICN Course Completion Certificate
• Current printout from BreEZe showing current license status.
• Current ACLS Card (front and back)
• Copy of photo identification (for example a California Drivers License)
• Submit the 4 MCI Field Operations ModuleCE Certificates (http://www.mvemsa.org), in compliance with Agency policy # 853.00 - Prehospital Training Standards. These will need to be done every 2 (two) years.
• Payment of the $100.00 non-refundable application fee
• Take and pass with a minimum of 75%, the Regional MICN Authorization Exam
• Take and pass with a minimum of 80%, the Regional ALS Treatment Protocol Exam
• Satisfactorily complete 10 ALS Radio calls. These calls must be documented on the Regional ALS Radio Call Evaluation Form and evaluated by an authorized Base MICN or Base Physician working in a Base Hospital Emergency Department. You may not obtain your 10 ALS calls until you have passed the Regional MICN Authorization and Regional ALS Treatment Protocol exams..
• Digital photo taken on site by Agency staff.

MICN Re-authorization - Online Only - We are currently closed to the public - No Walk-ins or Appointments.

Mountain-Valley EMS Agency does NOT accept applications via Fax or Mail

BEFORE APPLYING ON-LINE OR IN PERSON, MAKE SURE YOU HAVE ALL REQUIREMENTS!! APPLICATIONS WILL NOT BE PROCESSED UNLESS ALL REQUIREMENTS ARE MET! (see on-line requirements also).

• Submit a completed and signed pdf application (288 KB)   hard copy), OR by submitting online application below, that includes copies of:
  • Current printout from BreEZe showing current information
  • Copy of photo identification (for example a California Drivers License)
  • Proof of successful completion of 16* hours of Continuing Education (must be CE Certificates, cannot be a list of courses/hours completed).  MUST be relating to ALS care obtained during the current authorization period (CE MUST be a minimum of 1 hour, less than 1 hour is NOT accepted) 
  • Submit the 4 MCI Field Operations Module CE Certificates (http://www.mvemsa.org) not dated earlier than 90 days prior to re-authorization, (*These CE Certificates (total of 4 hours) can be used as part of your CE requirements for this authorization period), in compliance with Agency policy # 853.00 - Prehospital Training Standards.  These need to be done every 2 (two) years.
• Pay the non-refundable application fee of $50.00 by cash, check, money order, cashier's check, debit or credit. For online applications, if paying by credit or debit via PayPal, there will be a $5.00 processing fee.
• Digital photo taken on site by Agency staff, or provide a current passport style photo (passport photo or clear headshot/selfie with plain backgound), if applying online.
• A late fee of $15 will be assessed for authorizations processed after the expiration date,. Additional CE/documents are required if your MICN Authorization expires.  See Policy 261.00 - MICN Authorization/Re-Authorization for all additional requirements.

For Online  Applications:

• Please allow 5-7 business days for application processing and issuance of an MICN Reauthorization card once all requirements have been met.  NO EXCEPTIONS.
• Please make sure you have all required documents, including the passport style photo, saved and available for uploading PRIOR  to starting the application process.
• You will need to submit:
  
  • All items listed above for MICN Re-authorization
  • A current passport style photo (actual passport photo or a headshot/selfie against a blank wall).
  • Pay all fees, if applicable.
• Applications will not be processed until all required documents have been submitted and approved.  Incomplete applications will be maintained for up to 7 days to allow for submission of additional required documents.  All incomplete applications will be considered abandoned after 7 days.
• ALL FEES PAID ARE NON-REFUNDABLE.
• Incomplete applications that expire during processing shall be subject to a 15.00 late fee.

MICN Re-Authorization Application