Lorain County Fire Chiefs Association, Inc. Fire Training Academy – Charter 351 Registration Form Name* First Middle Last Certification NumberConfirm Certification NumberSSN (Only provide if this is for a State Certification)Supply last four digits if certification number is availableConfirm SSNDate of Birth* Date Format: MM slash DD slash YYYY Confirm Date of Birth* Date Format: MM slash DD slash YYYY Address* 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 IFirefighter I-T (need VFF cert to apply)Firefighter II-T (need FFI cert to apply)Fire Safety InspectorBlue Card Lab (March 10, 11 & 12 0830 to 1630)Firefighter I and I-Transition INSTRUCTORS: LCFCA Instructors CLASS TIME/DAYS: 6:00-10:00 Tues/Thurs and 9:00-5:00 Sundays CLASS SIZE: 12-30 COURSE HOURS: 84 COURSE DESCRIPTION: This course will build upon the basic skills taught in the Firefighter I course and completes the NFPA requirements for Ohio certification as a Firefighter 2. This course meets and exceeds the Ohio Revised Code for firefighters and the standards identified in the National Fire Protection Association (NFPA) Standards for Firefighter 2. Candidates must submit proof of a valid VFF certification from the ODPS for the FFI-T course. All participants must provide documentation indicating they meet all prerequisites. Specific requirements and personal protective equipment information can be obtained by contacting the Program Director at rhanmer@cityofoberlin.com. Students must also meet all requirements outlined by OAC4765-20-02. COURSE CONTENT: Meet the objectives for Firefighter I Certification. PREQUISITES: None for Firefighter I; Proof of VFF certification for FFI-T; Medical exam complete 1-year prior to the start of class; Proof of basic first aid training (EMT-any level or First Responder Certification will meet this requirement); Must be affiliated with a fire department and have compliant PPE including SCBA ENROLLMENT FEE: $1000 (including text or work books) COURSE REGISTRATION: Register by August 27, 2019 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 ChoiceEmailThis 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
