Lorain County Fire Chiefs Association, Inc. Fire Training Academy – Charter 351 Registration Form Name* First Middle Last Certification NumberConfirm Certification NumberSSN (For State Certification only. If this is for initial state certification, your full social security number is required. If you have a state certification (FF or EMT) only provide the last 4 digits of your SS#*Supply last four digits if certification number is availableConfirm SSN SSN (For State Certification only. If this is for initial state certification, your full social security number is required. If you have a state certification (FF or EMT) only provide the last 4 digits of your SS#*Date of Birth* Date Format: MM slash DD slash YYYY Confirm Date of Birth* Date Format: MM slash DD slash YYYY BLUE CARD (Select initial certification, renew certification or refresher)*Initial CertificationRenew CertificationRefresherAddress* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Course Applying For*Firefighter I Spring of 2026Each Department is limited to two participants until July 1, 2023. On July1, if there are any available seats, they will be filled on a first come, first served basis. Class Overview Operations: This course is designed to provide students with a complete understanding of HEV Vehicle Response and Hazard Management. Attendees will receive an academic presentation with question-and-answer periods built into every learning module. Attendees will also receive practical skills labs to interact with hybrid and electric vehicles. This course includes: • Vehicle Identification • HEV Electrical System Identification & Management • Hazardous Condition: o Cosiderations o Identification o Management o Environmental • ESA TOTAL PROTECTION Resourcing • Standards and Compliance PRACTICAL SKILLS • Risk Assessment • Fire Suppression • Extrication • Initial shutdown procedures • Vehicle Stabilization & Access • Secondary Shut Down Procedures • Vehicle loading and towing Sponsoring department or agency*Bill course fees to:*Sponsoring department or agency (in Lorain County)Direct to student (in Lorain County)Sponsoring department or agency (outside Lorain County)Direct to student (outside Lorain County)* Acknowledgement By submitting this application, I attest that the above information is true and correct to the best of my knowledge, and that I meet the pre-requisites for this training course. I hereby give permission to the Chartered Training Program to verify any of the above information and I will provide copies of all certifications at the time of application. I understand that I will be required to sign my application upon acceptance to this course. Upon receipt of a confirmation for this course, I also understand that I will be responsible to attend all sessions unless I notify the program in writing of my intent to withdraw no later than 48 hours prior to the first class date.UntitledFirst ChoiceSecond ChoiceThird ChoiceUntitledFirst ChoiceSecond ChoiceThird ChoicePost Custom FieldUntitledAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PhoneThis field is for validation purposes and should be left unchanged. CONTACT INFO430 South Main Street Oberlin, Ohio 44074info@oberlinfire.comPh: 440-774-3211 Fx: 440-774-7809
