National Fire Academy Emmitsburg, MD National Fire Academy Rules of Conduct Each individual has the personal responsibility to exhibit professional conduct while on the National Fire Academy campus. The designated representatives of the state training agency have the responsibility and authority to monitor and, along with campus security personnel, take necessary action to correct any unprofessional conduct. Campus security has the authority to request the name(s) of any individuals who may be disruptive or discourteous. It is expected that an individual’s name will be provided if requested. The security officer will then inform the state representatives of the circumstances surrounding the incident. In ALL instances of alleged misconduct, all parties will be responsible for deter- mining the facts. Decisions regarding dismissal of any student will be made at the conclusion of a review. The final authority for dismissal rests with the senior United States Fire Administration official on campus at the time. State representatives have the authority to dismiss any student for misconduct where the Incident occurs outside class hours.
Failure to Attend: “No Shows” Students should contact the New Hampshire State Coordinator(s) at 603-223-4200 or 1-800-371-4503 in the event it is necessary to cancel their attendance. Students who fail to cancel their reserved slot and fail to attend will be banned from attending National Fire Academy courses for a period of two consecutive years, as per NFA rules.
Security & Identification Requirements Each student MUST possess a Government Issued photo identification in order to register at C-West. Additionally, an NFA identification will be issued to each student and MUST be worn at all times when on the NFA campus. Vehicles entering or parking on the grounds of the National Emergency Training Center are subject to search, and armed security forces are posted at every entryway. Additional Information can be found at: https://training.fema.gov/emiweb/downloads/ netc_welcome_package.pdf
Meals
Friday evening: cold buffet-style dinner provided from 4:30PM to 7:00PM Saturday: breakfast, lunch, and dinner provided Sunday: breakfast and lunch provided Meal tickets will ONLY be available at the mandatory evening orientation at 6:00PM on Friday, August 18, 2017.
Dress Code The wearing of athletic clothing, including ball caps or hats of any kind, is not appropriate in the class- rooms, dining hall, or auditorium. Attire such as shorts, thongs, tank tops, ventilated shirts, collar-less shirts and cut-off jeans are consid- ered informal wear and should be restricted to after hour leisure activities. Required classroom and dining hall attire for your guidance: Males: Shirts with collars (NO T-shirts), slacks, nice jeans (with no holes) or department uniforms, shoes and socks. Optional items include sweaters and jackets, etc. Females: Dresses, blouses, (No T-shirts) with slacks or skirts, department uniforms, hosiery and shoes. Optional items include sweaters, jackets, etc.
Decision Making for Initial Company Operations This two-day course is designed to develop the decision making skills needed by Company Officers (CO) to accomplish assigned tactics at structure fires. All activities and scenarios used in this course are based on structure fires. With the real possibility of being the first to arrive at an incident, the CO’s initial decisions will have an impact throughout the entire incident. It is vital that Company Officers be able to make good management decisions that have a favorable impact on the eventual outcome. In addition to a possible role as the initial Incident Commander, the CO may well be assigned a subordinate position within the Incident Command System organization. Company Officers need to have a clear understanding of the system, the position that they are assigned to, and their role in the organization it they are to function effectively and help make the system work. Code: W0457
Executive Skill Series: Exercising Leadership Ethically This new two-day course provides students with the ability to recognize ethical dilemmas in the context of their envi- ronments, apply a decision model to resolve these dilemmas, render ethical decisions, and defend under scrutiny the resulting decisions that were made in an effort to resolve these dilemmas. This course will become the fourth offering within the Executive Skill Series. Code: W0523
Incident Command System and Resource Management for the Fire Service This is a significantly revised two-day program providing students with an understanding of the Incident Command System (ICS) and resource mamagement for the fire service and their application in both emergency and nonemergen- cy situations. This course addresses the need for an ICS, an overview of the structure and flexibility of ICS, an under- standing of the command skills necessary to function effectively in an ICS structure, and the need to effectively man- age your resources. This course meets the requirements of ICS-100 and ICS-200. Code: W0376
New Fire Chief: Challenging Issues This two-day course is designed to develop the managerial, admisistrative and leadership skills necessary for the first time fire chief and chief officer who desire a leadership position in their department. This course addresses critical knowledge and skills pertaining to the responsibilities of a fire chief, including such topics as local politics and the role of the chief officer, liability and risk manamgent, and resources and items of knowledge needed to become a first time leader in a new position in his or her agency. Code: W0760
Politics and the White Helmet This two-day course is aimed at providing the chief officers in both fire service and Emergency Medical Services (EMS) agencies with an overview of the ways to succeed and work within the political system at local, county and state levels to achieve positive results for their department. It will give the officer an improved insight into better ways to relate and speak to citizens and others in order to gain support and understanding of their needs for bond issues, tax votes and general elections. Participants learn about successful approaches that are appropriate for government employees and volunteers. The course identifies successful tools needed to address the challenge that is necessary to bring about change and how a department’s culture of power, influence, negotiation and coalition building is important to success. Code: W0121
Training Operations in Small Departments
This two-day course is designed to provide students with some basic tools and skills to coordinate training in a small fire/EMS organization. A training function in a smaller department typically may include conducting training drills and coordinating training with a nearby larger city or state training function. Course Content includes: Leadership issues, legal issues, safety considerations, marketing training internally, identifying ways to justify training needs, resolving training conflicts, selecting and evaluating training curricula and materials from outside sources, and effective delivery and evaluation of training. Code: W0290 DEPARTMENT OF HOMELAND SECURITY See Reverse for O.M.B. No. 1660-0100 FEDERAL EMERGENCY MANAGEMENT AGENCY Privacy Act Statement Expires November 30, 2016 GENERAL ADMISSIONS APPLICATION
SECTION I - GENERAL INFORMATION 1. U.S. Citizen YES NO PERMANENT RESIDENT If No, City and Country of Birth: 2. NAME (Last, First, Middle Initial, Suffix) 3. STUDENT IDENTIFICATION (SID) NUMBER
4. HOME MAILING ADDRESS (Street, avenue, road no, P.O. box/city or town, state, and zip code) 5. WORK PHONE NO.
6. HOME PHONE NO.
7. FAX NO.
8. E-MAIL ADDRESS: 9a. ENTER COURSE CODE AND TITLE: (If you wish to apply for more than one course, 9b. COURSE LOCATION 9c. DATES REQUESTED (Please give three choices) please attach a sheet of paper to this application)
10. COMPLETE THE ITEMS BELOW REGARDING THE PREREQUISITES OF THE COURSE FOR WHICH YOU ARE APPLYING INSTITUTION DEGREE/CERTIFICATE DATE EARNED COURSE/FIELD OF STUDY
11. DO YOU HAVE ANY DISABILITIES (Including special allergies or medical disabilities) WHICH WOULD REQUIRE SPECIAL ASSISTANCE DURING YOUR ATTENDANCE IN TRAINING? YES NO (If yes, describe & indicate any special assistance required on a separate sheet) SECTION II - EMPLOYMENT INFORMATION AND AUTHORIZATION 12a. NAME AND COMPLETE ADDRESS OF ORGANIZATION BEING REPRESENTED 12b. NFIRS # 13. CURRENT POSITION AND NUMBER OF (NFA STUDENTS ONLY) YEARS IN POSITION
14. CHECK THE BOX(ES) BELOW THAT BEST DESCRIBE YOUR ORGANIZATION 14 a. JURISDICTION 14 b. ORGANIZATION 15. CURRENT STATUS 1. STATEWIDE 4. SPECIAL DISTRICT/TOWNSHIP 7. FOREIGN 1. ALL CAREER 1. PAID FULL TIME 2. PAID PART TIME 2. COUNTY GOVERNMENT 5. FEDERAL/MILITARY (non-DHS) 8. DHS/FEMA 2. ALL VOLUNTEER 3. VOLUNTEER 3. CITY/TOWN/VILLAGE 6. INDUSTRY/BUSINESS 9. TRIBAL NATION 3. COMBINATION 4. DISASTER RESERVIST 16. Briefly describe your activities/responsibilities as they relate to the course for which you are applying and identify how you will use the information obtained from the course. Attach an organizational chart for the organization being represented and indicate your position. If you need more space, please attach a sheet to this application.
17. CHECK ONE BOX IN EACH COLUMN THAT BEST DESCRIBES YOUR PRESENT PRIMARY RESPONSIBILITY AND TYPE OF EXPERIENCE AS IT RELATES TO THE COURSE FOR WHICH YOU ARE APPLYING. ALSO ENTER THE NUMBER OF YEARS OF EXPERIENCE. 17a. PRIMARY RESPONSIBILITY 17b. TYPE OF EXPERIENCE 17c. NUMBER OF YEARS OF EXPERIENCE 1. MANAGEMENT 1. INCIDENT COMMAND 2. TRAINING/EDUCATION 2. ADMINISTRATION/STAFF SUPPORT 17d. SIZE OF DEPARTMENT 3. SCIENTIFIC/ENGINEERING 3. SUPERVISION 4. INVESTIGATION 4. BUDGET/PLANNING 17e. BUSINESS TYPE 5. FIRE PREVENTION 5. PROGRAM DEVELOPMENT/DELIVERY 1. GOVERNMENT 6. FIRE SUPPRESSION 6. COORDINATION/LIAISON 2. EDUCATION 7. PROGRAM/ACTIVITY PUBLIC EDUCATION 7. 3. FIRE SERVICE 8. HEALTH 8. CODE DEVELOPMENT 4. LAW ENFORCEMENT 9. PUBLIC WORKS 9. CODE ENFORCEMENT/INSPECTION 5. VOLUNTEER AGENCY 10. DISASTER RESPONSE/RECOVERY 10. SUPPORT SERVICES 6. EMERGENCY MANAGEMENT 11. EMERGENCY MEDICAL SERVICE 11. RESEARCH AND DEVELOPMENT HEALTH CARE 12. HAZARD MITIGATION 12. ARSON 7. 13. EMERGENCY PREPAREDNESS 13. LAW ENFORCEMENT 8. PUBLIC WORKS 14. OTHER 14. DESIGN AND PLANNING (Specify) 15. OTHER (Specify) 18. DATE OF BIRTH 19. GENDER Male Female 20. RACE (Please check all that apply) 20a. Ethnicity AMERICAN INDIAN or BLACK or AFR ICAN NATIVE HAWAIIAN or HISPANIC or NOT HISPANIC 1. 2. ASIAN 3. WHITE 5. ALASKAN NATIVE AMERICAN 4. PACIFIC ISLANDER LATINO or LATINO
FEMA Form 119-25-1, (2/12) PREVIOUS EDITION FF75-5 OBSOLETE
SECTION III - ENDORSEMENT AND CERTIFICATION
21a. I certify that the information recorded on this application is correct. Falsification of information will result in denial of a course certificate and stipend (18 U.S.C. 1001).
21b. I hereby authorize the release of any and all information concerning my enrollment in this course to the chief officer in charge, or designee, of my organization. All requests for information shall be in writing from said chief or designee.
21c. Further, I understand that the National Emergency Training Center (NETC), the Mt. Weather Emergency Operations Center (MWEOC), and the Noble Training Facility (NTF) are not authorized to provide medical or health insurance for students. I maintain appropriate insurance on an individual basis.
21d. I agree to abide by the rules, policies, and regulations of NETC, MWEOC, and NTF. Failure to do so will result in denial of the student stipend, expulsion from the course, and possible barring from future National Fire Academy (NFA) and Emergency Management Institute (EMI) courses.
SIGNATURE OF APPLICANT DATE
22. APPROVAL BY THE HEAD OF THE SPONSORING ORGANIZATION
"By signing this application, I certify that my organization does not discriminate on the basis of age, gender, race, color, religious belief, national origin, economic status, or disability in providing educational opportunities for its employees." 22a. SIGNATURE 22b. PRINTED NAME AND TITLE
23. ADDITIONAL ENDORSEMENTS FOR APPLICATION TO THE EMERGENCY MANAGEMENT INSTITUTE: 23a. SIGNATURE AND DATE (State Office) 23b. SIGNATURE AND DATE (FEMA Regional Office)
24a. FOR NFA REGIONAL DELIVERY COURSES AND COURSES 24b. FOR EMI COURSES DELIVERED AT NETC, MWEOC, OR NTF DELIVERED AT EMMITSBURG, MD. SUBMIT APPLICATION TO: SUBMIT APPLICATION THROUGH THE APPROPRIATE STATE EMERGENCY MANAGEMENT COORDINATOR OR FEMA REGIONAL TRAINING MANAGER TO NETC. NATIONAL EMERGENCY TRAINING CENTER OFFICE OF ADMISSIONS, BLDG. I-216 16825 SOUTH SETON AVENUE 24c. FOR FIELD PROGRAM COURSES, SUBMIT APPLICATION TO EMMITSBURG, MD. 21727 APPROPRIATE SPONSOR.
25. DISPOSITION SIGNATURE OF REVIEWER DATE ACCEPTED REJECTED
EQUAL OPPORTUNITY STATEMENT
NFA and EMI are Equal Opportunity institutions. They do not discriminate on the basis of age, gender, race, color, religious belief, national origin, or disability in their admissions and student- related procedures. Both schools make every effort to ensure equitable representation of minorities and women in their student bodies. Qualified minority and women candidates are encouraged to apply for all courses. PRIVACY ACT STATEMENT
GENERAL - This information is provided pursuant to Public Law 93-579 (Privacy Act of 1974), Title 5 United States Code (U.S.C.) Section 552a, for individuals applying for admission to NFA or EMI.
AUTHORITY - Federal Fire Prevention and Control Act of 1974, as amended, Title 15 U.S.C., Sections 2201 et. seq.; Robert T. Stafford Disaster Relief and Emergency Assistance Act, as amended, Title 42 U.S.C., Sections 5121 et. seq.; Title 44 U.S.C., Section 3101; Executive Orders 12127, 12148, and 9397; Title VI of the Civil Rights Act of 1964; and Section 504 of the Rehabilitation Act of 1973.
PURPOSES - To determine eligibility for participation in NFA and EMI courses. Information such as age, gender, and ancestral heritage are used for statistical purposes only.
USES - Information may be released to: 1) FEMA staff to analyze application and enrollment patterns for specific courses, and to respond to student inquiries; 2) a physician to provide medical assistance to students who become ill or are injured during courses; 3) Members of the Board of Visitors for the purpose of evaluating programmatic statistics; 4) sponsoring States, local officials, or State agencies to update/evaluate statistics of NFA and EMI participants; 5) Members of Congress seeking first party information; and 6) Agency training program contractors and computer centers performing administrative functions.
EFFECTS OF NONDISCLOSURE - Personal information is provided on a voluntary basis. Failure to provide information on this form, however, may result in a delay in processing your application and/or certifying completion of the course.
PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this data collection is estimated to average 9 minutes. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and submitting this form. You are not required to respond to this collection of information unless a valid OMB control number is displayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 1800 South Bell Street, Arlington, VA 20598-3005, Paperwork Reduction Project (1660-0100) NOTE: Do not send your completed form to this address.
1 New Hampshire Department of Safety Division of Fire Standards and Training & Emergency Medical Services 33 Hazen Drive, Concord, NH 03305 1-800-371-4503 or 603-223-4200 FAX: 603-271-1091
New Hampshire / Vermont / Alabama Three- State Weekend Application, 2017 NOTE: This application form must be completed, with signatures in place, and returned with payment indicated/included. Please be sure to include your Federal Student Identification (SID) number on your application. Illegible, hard-to-read applications will be returned. Applications being accepted NOW through the close of business on Friday, July 21, 2017.
Section 1: PERSONAL INFORMATION
Y N United States Citizen? Applicants to Three State Weekend must be citizens of the United States of America.
M F Last 4 digits DOB: Name: of SSN: (mm/dd/yyyy)
Home address City: State: Zip:
Home Work Cell Phone: Phone: Phone: NOTE: Please list cell provider company name if you want to receive text Cell Phone message confirmations. (Standard text message rates may apply.) Provider:
Email address:
Preferred method of contact for confirmation: Email/Text Mail Dept. Dept. Dept. Name: Phone: Fax: T-Shirt Size: S M L XL 2XL 3XL NOTE: I have read and understand the NFA Rules of Conduct and Student Dress Code which will be in effect during my stay at the National Fire Academy. Applicant Date Signature: (mm/dd/yyy): Section 1B: SID NUMBER (Required for National Fire Academy courses!)
Click on or copy and paste the link for information: SID NUMBER https://cdp.dhs.gov/femasid/Register.aspx
Section 2: COURSE INFORMATION (YOU MUST CHOOSE THREE!) Selection will be on a first-come, first-serve basis. 1. Code #: Abbrev.: EARLY registration is encouraged in order to secure your first 2. Code #: Abbrev.: place. Please indicate your course selections in order of preference. 3. Code #: Abbrev.: Section 3A: DEPARTMENT PAYMENT Dept. Representatives: Check one of the following two choices: TUITION: $150.00 Yes, my agency/dept. agrees to pay tuition upon billing from the Division and is aware of the refund policy which is located
on the Division’s website: http://www.nh.gov/safety/divisions/fstems/documents/fstemsrefundpolicy.pdf
No, my agency/dept. does not agree to pay tuition for this applicant.
Section 3B: DEPARTMENT REPRESENTATIVE VERIFICATION SIGNATURE Dept. Rep. Date Signature: (mm/dd/yyyy):
NOTE: If you are paying for your own tuition, please fill out the “General Payment Form” on the next page. New Hampshire Department of Safety Division of Fire Standards and Training & Emergency Medical Services Mailing: 33 Hazen Drive, Concord, NH 03305 Physical: 98 Smokey Bear Blvd., Concord, NH Phones: (Toll Free) 800-371-4503 (Local) 603-223-4200 (Fax) 603-271-1091 Three State Weekend 2017 General Payment Form
This form is to be used if your department / agency is NOT paying for your tuition. Please be sure to fill in all requested information. Please submit this form along with your applications and shuttle bus confirmation form.
Section 1: APPLICANT INFORMATION First Middle Init. Last NAME:
Last 4 digits of S.S. #: Date of birth: (mm/dd/yyyy) THREE STATE WEEKEND TUITION $150.00 Section 3: PERSONAL PAYMENT INFORMATION Check off one method of payment listed below. Please make checks or money orders payable to NHFSTEMS and submit along with your completed application for Three State Weekend.
Full name listed Personal Check on credit card:
Money Order / Bank Check Card number:
3-digit code #: VISA Expiration date: (on back of card)
Master Card Amount: $
Signature American Express (as it appears on card):
For further information on the division’s refund policy, please refer to the NHFSTEMS website: http://www.nh.gov/safety/divisions/fstems/documents/fstemsrefundpolicy.pdf
FOR OFFICE USE ONLY: