January and February 2023 CFA Courses Application

CPAT REGISTRANTS: DO NOT SUBMIT AN APPLICATION. ENROLL DIRECTLY ON THE CFA WEBSITE

Registrar's comments

MUST BE 18 YEARS OF AGE TO PARTICIPATE IN HANDS-ON TRAINING

Except for: The Introduction to the Fire Service Courses

Are you 18 years of age or older?*

YesNo

Filtered Last Name

Filtered First Name

First Name*

Last Name*

Last 4 of SSN*

Username:

This is your username for the CFA Learning Website

Email*

example@example.com (use same email entered into SABA)

Check to subscribe to CFPC list serve.

Address

Street Address

Street Address Line 2

City

State

Zip Code

Cellphone Number*

Department Type:

January 2023 Calendar Course Selection. Please note: if a class is not on this list then it is full/canceled and is not available for enrollment.

You may choose multiple courses on the same form

Cold Water Rescue ($90)

EMR Refresher ($250)

Fire Officer I ($440)

Fire Officer II ($385)

Fire Officer III ($410)

Fire Service Instructor I ($430)

Fire Service Instructor II ($330)

Post Pandemic Leadership ($100)

2023 Connecticut/ Delaware Fire Service Weekend ($165)

Youth Fire Setter Intervention Specialist ($100)

Q Endorsement - Train-the-Trainer: Drag classes up/down to display your order of preference (ie re-sort the dates)(Do not sign up on our learning website) (No charge)

Picture of license required for Pump Operator, Aerial Operator & Q endorsement Classes (upload using button below):

Upload

Drivers License Number

Expiration Date

Please upload any Out of State Prerequisites (if applicable):

Upload

If paying by credit/debit card or paypal, please go to CFA learning website to complete the enrollment process. This is a secure site for credit/debit card and paypal payment.

If paying by host seat/PO (click no on the credit card question) please fill in the information below (applicant will not be accepted if information is missing)

Paying by credit/debit card/paypal*

YesNo

Host Seat

YesNo

Purchase Order #

Fire Department Chief/Training Officer/Organization Supervisor (Person authorizing applicant participation)

Approver First Name*

Approver Last Name*

Approver Email*

example@example.com

Primary Phone Number*

FDID #

Fire Department/Organization: (organized by city/town)*

If department not found or incorrect in above list, please enter here. (please make sure you looked at the correct town/city)

I hereby authorize the above applicant to participate in the program below and, therefore, understand that the above named individual will be covered by my organization’s Worker’s Compensation Insurance while participating in such training, and that the Commission on Fire Prevention and Control, its commissioners, officers, agents or employees shall not be liable for any injuries sustained during such training. This applicant is considered by my department’s standards to be physically and emotionally fit to perform firefighting evolutions without special considerations, and where applicable, to meet the 29 CFR 1910.134 standard for the use of respirators (Self-Contained Breathing Apparatus). No application will be accepted without an authorized signature.

CFA classes: Signature of Fire Department APPROVER required. Youth Firesetter Intervention Specialist & Post Pandemic Leadership you may sign the form yourself*

Clear

Date Signed*

MonthDayYear

Click SAVE: To email the form to your approver for a signature, or other missing information. On next screen, click "Skip Create an Account." On next screen, type in your Approver's email address and click "send link."

Click SUBMIT: If your form is complete

Questions? please contact support

If paying by credit/debit card or paypal, please go to CFA learning website to complete the enrollment process. This is a secure site for credit/debit card and paypal payment.

January & February 2023 Connecticut Fire Academy Courses Application