EMT Career Guide
How to Become an EMT in Texas
Becoming an Emergency Medical Technician in Texas takes four things: an approved EMT course, the National Registry exam, a fingerprint background check and a Texas DSHS certification. Here is the full path, step by step, with real costs and timelines.
By Charles E. Myles II, B.S., L.P., owner of Elite Medical Training Solutions. Updated October 2026.
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Requirements to become an EMT in Texas
To be certified as an EMT by the Texas Department of State Health Services (DSHS), you must:
- Be at least 18 years old
- Have a high school diploma or GED certificate
- Complete a DSHS approved EMT course
- Pass the National Registry of Emergency Medical Technicians (NREMT) exam
- Submit fingerprints for an FBI criminal history check
- Apply to DSHS and pay the certification fee
Seven steps to EMT certification
Enroll in a DSHS approved EMT course
Choose a course approved by DSHS. The EMTS EMT-Basic Hybrid course runs 14 weeks with online lessons, in-person skills labs and clinical rotations in Mission, Texas.
Clear your clinical requirements
Clinical sites require a background check, immunizations and a drug screen before you can rotate. At EMTS these are included in tuition.
Complete coursework, skills and clinicals
You learn assessment, airway, trauma, medical emergencies and operations, practice hands-on skills, and complete 60 clinical hours: 48 on an ambulance and 12 in a hospital emergency department.
Pass your skills verification
Your psychomotor skills are verified through your approved program before you finish. EMTS administers skills testing as part of the course.
Pass the National Registry exam
Create an account with the National Registry, apply ($104 per attempt) and schedule your cognitive exam at a Pearson VUE test center. Your Authorization to Test is valid for 90 days.
Get fingerprinted
Schedule a fingerprint appointment with IdentoGO using the DSHS service code shown on your online application. The fingerprinting fee is paid when you schedule.
Apply for Texas certification
Apply through the DSHS online licensing system with your National Registry number, your course approval number and your course completion date, then pay the $64 fee. Processing can take up to four weeks.
What it costs to become an EMT in Texas
| Cost | Amount | Paid to |
|---|---|---|
| EMTS EMT-Basic tuition | $2,000 | EMTS (deposit plus payment plan available) |
| Textbook, polo, background check, immunizations, drug screening, liability coverage | Included | Included in EMTS tuition |
| National Registry application | $104 per attempt | NREMT |
| Texas EMT certification | $64 | DSHS |
| Fingerprinting | Set by IdentoGO | IdentoGO |
That puts the total at about $2,168 plus fingerprinting. See how that compares with other local programs on our Tuition and Payment Plans page.
How long it takes
| Stage | Typical time |
|---|---|
| EMTS EMT-Basic Hybrid course | 14 weeks |
| Schedule and take the National Registry exam | Within 90 days of applying, often within a few weeks of finishing |
| DSHS processing | Up to 4 weeks |
| Certificate delivered to your DSHS account | Within 2 weeks of issue |
From the first day of class to a Texas certificate is usually about four to five months. You can get fingerprinted while you wait on your exam so DSHS has everything when you apply.
The National Registry EMT exam
The EMT cognitive exam is a computer adaptive test (CAT). You answer between 70 and 120 questions within 2 hours, and the exam adjusts to how you answer. It covers five domains:
| Domain | Share of the exam |
|---|---|
| Scene Size-Up and Safety | 15% to 19% |
| Primary Assessment | 39% to 43% |
| Secondary Assessment | 5% to 9% |
| Patient Treatment and Transport | 20% to 24% |
| Operations | 10% to 14% |
- If you do not pass, you can retest 15 days after your last attempt.
- You have six chances to pass. After three unsuccessful attempts you must complete remedial education before your fourth.
- Your course completion is valid for National Registry testing for two years.
Keeping your certification
Texas EMT certification lasts four years. You can renew by keeping your National Registry certification current, by completing approved continuing education, by passing the National Registry assessment exam, or by taking a formal recertification course of at least 48 hours. Every Texas renewal also requires the EMS jurisprudence exam on Texas EMS laws and rules.
National Registry certification renews every two years and requires 40 credits of continuing education.
What comes after EMT
Many EMTs work on ambulances, in emergency departments, with fire departments and in event medicine. Others keep going. The next level is Advanced EMT, which adds IV and IO access, advanced airway devices and more emergency medications. Read EMT vs AEMT: What is the Difference? or see the EMTS Advanced EMT course.
Frequently asked questions
How long does it take to become an EMT in Texas?
Most students go from the first day of class to a Texas certification in about four to five months. The EMTS EMT-Basic Hybrid course runs 14 weeks. After that you take the National Registry exam, then DSHS can take up to four weeks to process your application.
How much does it cost to become an EMT in Texas?
At EMTS, tuition is $2,000 and includes your textbook, polo, background check, immunizations, drug screening and liability coverage. Add the $104 National Registry application fee, the $64 DSHS certification fee and your fingerprinting fee. See Tuition and Payment Plans.
Do I need a high school diploma to become an EMT in Texas?
Yes. DSHS requires a high school diploma or GED certificate, and you must be at least 18 years old to be certified.
Can I take the EMT course online?
The EMTS course is hybrid. Lessons are online each week, and skills labs and clinical rotations are in person, because hands-on skills have to be practiced and verified in person.
What is on the NREMT EMT exam?
The EMT cognitive exam is a computer adaptive test with five domains: Scene Size-Up and Safety, Primary Assessment, Secondary Assessment, Patient Treatment and Transport, and Operations. You answer between 70 and 120 questions within 2 hours.
What happens if I fail the National Registry exam?
You can retest 15 days after your last attempt. You have six chances to pass, and after three unsuccessful attempts you must complete remedial education before your fourth.
I have a criminal record. Can I still become an EMT?
It depends on the record. DSHS offers a criminal history pre-screen petition ($52) so you can find out before you enroll whether a record could prevent certification.
How often do I renew my EMT certification?
Texas certification lasts four years. National Registry certification renews every two years. Many Texas EMTs renew their state certification by keeping their National Registry certification current.
Start your EMT career
EMTS runs EMT-Basic and Advanced EMT hybrid courses in Mission, Texas, with seats limited to 30 per class.
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