Follow the steps to complete your application with ease.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In section A, enter your contact information. Fill in the EMS Agency name, along with the mailing address, city, state, and zip code. Include the contact person's name, email address, and phone number.
3. Move to section B and provide details about the AWIN Installation/Repair Provider. Here, enter the AWIN Provider Name, the contact person's name, and their phone number.
4. In section C, fill in the vehicle information. Specify whether it is a ground ambulance or a rotor wing air ambulance. For new installs, provide the vehicle identification number (VIN) or tail number. If transferring a radio to another vehicle, provide the VIN or tail numbers for both the old and new vehicles.
5. Proceed to section D to input radio information. Indicate whether the radio is mobile or portable and specify the radio model type. If the radio is owned by the Arkansas Department of Health, select 'Yes' and provide the serial number. If not, select 'No' and list the owner's name.
6. Answer whether this AWIN radio is replacing another AWIN radio. If 'Yes,' provide the serial number of the radio being replaced. Add any additional information that may be relevant.
7. Finally, save your changes. You may choose to download, print, or share the completed form as needed.

Take the next step and complete the AR DoH Trauma Awin Radio Application online today.