FIELD COURSE APPLICATION/APPROVAL

Select Course Title
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Which Textbook Are You Using?
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Select County
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Host Department/Agency
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Chief/Agency Representative
First Name
Last Name
Cell Phone
Email
Verify Email
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Course Coordinator First Name
Course Coordinator Last Name
SSN
(ex. 123456789)
The SSN entered does not
match that in our database.
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Address   
City State Zip
County
Home Phone
Cell Phone
Office Phone

Coordinator Email
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Location Details
Course Dates: Beginning
   		Ending
  

Instructor/JPR Evaluator Information

LEAD SSN
(ex. 123456789)
The SSN entered does not match that in our database. Please try again.
The SSN entered is a duplicate. You cannot enter the same SSN more than once on this form.
This instructor is not qualified to teach this course.
NOTE: If an addtional lead instructor is required, Click Here to add another lead instructor


ASSIST SSN
(ex. 123456789)
The SSN entered does not match that in our database. Please try again.
The SSN entered is a duplicate. You cannot enter the same SSN more than once on this form.
This instructor is not qualified to teach this course.
NOTE: If an addtional assistant instructor is required, Click Here to add another assistant instructor

Participant Information:
Seats Available
Reserved Seating
Open Registration

Seats Available is the maximum number of students in the course. Reserved Seating is the number of your employees or participants. Open Registration is the number of additional participants that you will allow to register online to attend without first contacting you.


NOTE: For each class number, please enter all associated information on one line. (ex. "Subjects" information should be in one box, not on another line for continuation.)
Class No. Hours Date Class Hours From-To Subjects Instructor Location
1
2
3
4
5
6
7
8
9
10
11
12
13

Total Hours  

If any of these dates, hours, or the assigned instructor change, you must notify YOUR AFC Regional Director/Coordinator.

Requested Skills/JPR Test Date: Time:
Hour
 Minute
 AM/PM
Location:
Requested Written Test Date: Time:
Hour
 Minute
 AM/PM
Location:

PLEASE GIVE BRIEF INSTRUCTIONS FOR TRAVEL TO:

Classroom Site:   

Drill Field Site:   

The Digital Signature below is required in order to submit this form.

By checking this box I certify that I have the authority to schedule this course on behalf of the host entity and agree to the terms as set forth by the Alabama Fire College and Personnel Standards Commission.

Course Coordinator  


   NOTE: Only hit the submit button once. You will receive email confirmation if the submission was successful.