Fire Academy Registration Fire Academy Registration Date of Application First Name * Last Name * Address * Address Address Address County County City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Phone * Email * Any Medical Documentation Drop a file here or click to upload Choose File Maximum file size: 516MB DFS Number If no DFS# Last 4 of SSN EMT ID Number Course Name * Course Number * Course Start Date * Do You Meet Course Prerequisites * Yes No Course Prerequisites Drop a file here or click to upload Choose File Maximum file size: 516MB Emergency Services Affiliation Dept Name * Emergency Services Affiliation Phone Number * If you are human, leave this field blank. Next
