Standard Training Course Application Form #1063

INSTRUCTIONS:

This course application must be COMPLETED for EACH student. This is REQUIRED even for members of the host agency. STUDENTS MUST BE PRE-REGISTERED by the course deadline (if a deadline is posted).
Enter Fire Department FDID# for Fire Courses -OR- enter your EMS Agency Code for EMS courses; and the date the application is submitted.
Applicants must notify the Training & Operations Center 48-hours prior to the scheduled course start if they WILL NOT be able to attend the course requested. Your agency may be invoiced for your failure to attend courses registered for.

Complete this form to apply for a training course.

This does not confirm that you are in the class - only that we have received your online request.

A copy of your completed application form will be emailed back to you, acknowledging receipt of your request in our online system.

Please contact our office at the Fire Safety Division with any questions or concerns 716-681-7111.

First Name

Middle Initial

Last Name

Please put your NYS Fire ID # or your last 4 SS# if you don't know it

Rank or Title

Street Address

City, State, Zip

Cell Phone

Home Phone

Email

Your Training Chief's Email

I am 18 years old or older

Course #

Course Title

Course Host Location

Class Start Date

Class End Date

Agency Supervisors Name, Title, and Phone #

I have medical clearance to use Self Contained Breathing Apparatus SCBA in accordance with OSHA 1910.134

Is authorized/capable of using SelfContained Breathing Apparatus (SCBA) and participating in live fire training and operations