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Course Request Form

This form will be directed to the Full Time Uniformed Field Captain that services your area. They will process the request and will contact you in regards to specific details as needed.

CLICK HERE for Terms and Conditions of programs

CLICK HERE for FIELD CAPTAIN TERRITORIES

CLICK HERE for the blank course schedule template

Course Request Information

SECTION 1: Course Information
Course name *
If other, please specify
Course start date *
Course end date *
Course Location *
AddressAddress Line 2CityState / Province / RegionPostal / Zip CodeCountry
SECTION 2: Agency or Department Information
Requesting agency official name *
Address *
AddressAddress Line 2CityState / Province / RegionPostal / Zip CodeCountry
Email *
Phone *
Fax
SECTION 3: Agency Approval
I, as a representative of the agency sponsoring and hosting the course, do hereby pledge our agency's support of the course by providing the use of facilities, apparatus and/or equipment which are necessary to properly conduct the training course. *
I agreeI DO NOT agree
Name of attesting representative above *
SECTION 4: Fire Standards and Training and EMS Approval For Fire Academy use ONLY
Bureau Chief Approval
YesNo
Date of approval
Funding *
Funded - SubsidizedNon-SubsidizedNon-Funded
Standard Min and Max # of students
Yesno
Other minimum
Other maximum
SECTION 4a: Application Window
Application window open date
Notes (ie close 60 days out)
SECTION 4b: Advertising Information
Advertise
YesNo
Add will be submitted by outside agency (for non funded programs)
YesNo
Upload the course schedule here (use download template from above link at top of page)

Verification

Please enter any two digits with no spaces (Example: 12) *
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