Application for Wildfire Suppression Kit

Fire Department: FDID:

Mailing Address:

Physical Address:

County: Forestry District:

Fire Chief:(Print) Chief Phone #:

Fire Chief:(Sign) Email:

Eligibility Conditions: To apply for this grant the fire department must serve a community with a population of less than 10,000, and no more than 25% of the firefighters are paid.

1) Approximate population of fire district?

2) Number of active firefighters? *Active firefighter is a member of a fire department or organization in good standing that is qualified to respond and extinguish fires or perform other fire department emergency services and has actively participated in such activities during the past year. – 44 CFR §152.2 Definitions.

3) What percentage of active firefighters are volunteer?

4) When was the last time your department received a Wildfire Suppression Kit from the Rural Fire Protection office? 1-2 years ago 3-4 years ago 5-7 years ago Never

5) What is your fire departments ISO rating? (if a split rating indicate both)

6) How many square miles does your fire district cover?

7) Will your fire department respond to fires outside your district if officially requested? Yes No

8) Does your fire department have signed mutual aid/automatic aid agreements with other departments? Yes No

9) Is your fire department currently serving as an active Firewise Community? Yes No

10) Does your fire department report fires to the National Fire Incident Reporting System (NFIRS)? Yes No

11) On average how many grass/brush/forest/wildfires does your department respond to in a year? (Include responses that have been officially requested to aid another department) More than 20 16-20 11-15 5-10 Less than 5

12) Does your fire department have sufficient wildland PPE to equip your firefighters? No, we have none We have some but are lacking Yes

Please return to the attention of your District Forester:

District 1: District 6: District Forester, Trey Franks District Forester, Chuck Primeaux 1327 Scogin Dr. Monticello, AR 71655 P.O. Box 522 Clarksville, AR 72830

District 2: District 7: District Forester, Shane Booth District Forester, Bryan Aday P.O. Box 134 N Main St. Dierks, AR 71833 P.O. Box 10 Greenbrier AR 72058

District 4: District 8: District Forester, Cory Bostic District Forester, Michael Mowery 2501 Maul Rd. Camden, AR 71701 P.O. Box 26 Ash Flat, AR 72513

District 5: District Forester, John Cook 207 Airport Rd. Malvern, AR 72104

PPE Request Information

Fire Department:

Address:

Primary Contact & Phone Number:

Alternate Contact & Phone Number:

E-mail:

Please be sure to fill out all of the contact information. This is how we get the kit to you.

Be advised that quantity of PPE purchased will depend on cost of the equipment.

Please identify up to 10 sizes of Wildland Coveralls & Gloves.

Quantity (10) # Coverall size: Small-5XL, Medium Tall - 5XL Tall

Quantity (10) # Glove sizes: Small-2X