CBBP Recognized Qualification Application Form

Wisconsin Certified Burn Boss Program: Recognized Qualification Application
Please make sure that you have read and understood all information in the CBBP landing page (https://prescribedfire.org/cbbp/) before proceeding. It is recommended to read through the entire application below before starting to fill out information.

Select "Save" below to save your progress (select "Skip Create an Account" if you do not wish to create a Jotform account). Please note that saved drafts are automatically deleted after 2 months OR after the application is submitted.

The only credentials currently approved for this CBBP application track are NWCG RXB1/RXB2 certification or active status as a Wisconsin DNR burn boss. To submit a different credential for consideration (such as another state's Prescribed Burn Manager Program), or to receive assistance with your CBBP application, contact certification@prescribedfire.org.
Section 1: Applicant Information
Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Employer's Name (if applicable):
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
A member of the CBBP Certification Board may contact you as part of the review process.Format: (000) 000-0000.
Email
A member of the CBBP Certification Board may contact you as part of the review process.
Section 2: Prescribed Burn Experience and Credentials
This section requires detailed documentation of your prescribed fire credentials. The CBBP Board may choose to contact you at any time to verify the information provided and/or your eligibility for the CBBP.
Years of Prescribed Burn Experience
Please upload your relevant credential here.

This credential must be either a NWCG RXB1 certificate, a NWCG RXB2 certificate, or the front page of an IQCS record.
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Section 3: Signature and Payment
Before proceeding, please make sure you have read the CBBP Code of Conduct and Grounds for Sanction or Revocation of Certification as well as the following privacy notice:

Personal identifiable information is information about an individual that is readily identifiable to that specific individual. Personal information includes personal identifiers such as your name, date of birth, Social Security Administration account number, street address, telephone number, internet protocol address and email address. The state collects no personal identifiable information unless you voluntarily participate in an online activity that asks for this information (i.e. sending an email, participating in a survey, completing an application form).

If personal information is requested or volunteered by the user, state law and the federal Privacy Act of 1974 may protect it. However, information provided is public record which may be subject to public inspection and copying if not protected by federal or state law. The Wisconsin Certified Burn Boss Program will maintain a public facing list of Certified Burn Bosses; if you would not like to be listed on this resource, please indicate this on your application. We strive to protect personally identifiable information by collecting only information necessary to deliver our services. In the event of a conflict between this privacy notice and the Wisconsin open records law or other law governing the disclosure of records, the Wisconsin open records law or other applicable law will control.
I have read the above privacy notice.
Initial here
I have read and agreed to the CBBP Code of Conduct and Grounds for Sanction or Revocation of Certification.
Initial here
I certify that all information included in this application is true and correct.
Initial here
Signature
Do you consent to be listed on the Wisconsin Certified Burn Boss Program's public facing list of Certified Burn Bosses?
Certified Wisconsin Burn Bosses are qualified to help other CBBP applicants achieve certification through mentorship and evaluation. This can be as simple as supervising an applicant on a single burn. It can also include supervising an applicant and filling out a Performance Evaluation Checklist. The WPFC is developing a directory to pair burn boss trainees with potential mentors and evaluators.

Please indicate below whether you would like to be listed in WPFC's directory of by-request CBBP mentors or evaluators upon your own certification. You will not be required to fulfill mentorship/evaluation requests and you may choose to be removed from the directory at any time.
Do you want to be listed on the WPFC's directory of potential CBBP mentors/evaluators?

Payment

CBBP Application Fee

This nonrefundable fee is required to apply to the CBBP. An additional $55 certification fee is required upon application approval.

$105.00 Quantity

Payment Methods

Credit Card

Apple Pay

Google Pay

ACH Bank Transfer

Contact certification@prescribedfire.org for assistance with payment or any other application components. Be sure to save your progress beforehand by clicking the "Save" button below.
Should be Empty:

Wisconsin Certified Burn Boss Program: Recognized Qualification Application

Section 1: Applicant Information

Section 2: Prescribed Burn Experience and Credentials

Section 3: Signature and Payment

Payment

Payment Methods