WELCOME TO THE ANNUAL FLORIDA STATE WEEKEND AT THE NATIONAL FIRE ACADEMY IN EMMITSBURG, MARYLAND We hope you will have the opportunity to join us this year! The education you receive from experienced instructors, the networking you do with fellow students, and the sharing of collegial experiences is the success behind the Florida State Weekend program. I am sorry to report that our colleagues from Maine are not able to join us this year! As a result, our course lineup has been reduced to three offerings this year. REGISTRATION AND INFORMATION Registration Fee for the weekend is $90. This includes a Meal Card valid from Friday night dinner thru lunch on Sunday; a Pub Pass; and a 2017 NFA State Weekend Polo Shirt. Your lodging is provided FREE courtesy of the NFA. Registration at NFA: Is in lobby of Building C-West. You need to present photo identification at the NFA campus entrance, and also at the Registration Desk in Building C-West. (FL Driver s License is accepted.) If you are driving a vehicle, the license plate number is also required at time of registration. All students are issued an NFA Photo Identification Badge that must be worn at all times when on campus, and always presented to security upon returning to campus. Arrival Time: You are required to arrive at the National Fire Academy between 5:00-7:00 p.m. on Friday, April 28, 2017 for registration. If you are unable to arrive between these hours, please call me the National Fire Academy at (301) 447-1048 and ask that a message be delivered to Florida State Weekend staff. STATE WEEKEND PROGRAM ORIENTATION: Friday night at 7:30 p.m. You MUST attend. CLASS: Start /End times for class will be at the discretion of each instructor. Flying To/From NFA: you will need to arrange for your own transportation from the airport to the National Fire Academy. NETC/NFA no longer provides ground transportation to and from the airport. If your flight is delayed, call the NFA Office (304) 447-1113. Dismissal on Sunday will be approximately 4pm. Make your travel arrangements on Sunday accordingly. BE SURE TO FACTOR IN DRIVE TIME TO THE AIRPORT REGISTRATIONS: National Fire Academy requires all applications be received six weeks in advance. Therefore, March 26, 2016 is the deadline for submitting your registration. PAYMENT: Payment is due in full at the time your Registration is submitted. Checks should be made payable to: NW FL VOL WEEKEND COUNCIL. In the Memo Area of your payment, write 2017 NFA State Weekend. CANCELLATIONS: Cancellations received after March 17, 2017 are subject to the NFA's Cancellation Policy. REFUNDS: No refunds for cancellations after April 1, 2017. EMERGENCY: If you have an emergency situation arise and cannot attend, you need to contact Patrick Giacobbe or Angie Cain at: (352) 369-2800. IMPORTANT: STUDENT IDENTIFICATION NUMBER Each student must obtain a Student Identification Number (SID) in lieu of using your Social Security number for registration. The process is very easy. If you already have an SID, you must use that number. Do not reapply for a new number! Go to https://cdp.dhs.gov/femasid/register.aspx and register. You will instantly receive your SID. Use your SID number when completing FEMA Form 119-25-2, (2/12). NOTE: Keep your SID number! Use this SID for all future courses, as well as pre-/post-courses, affiliated with NETC-NFA at the NFA in Maryland or for Florida in-state NFA programs.
COURSE SELECTION: 1. (W0609) INTRODUCTION TO UNIFIED COMMAND FOR ALL HAZARD INCIDENTS (NEW) Curriculum: Incident Management. This course is designed to provide company officers with a better understanding of multiagency needs and a Unified Command structure. Attendees will gain the knowledge and skills necessary to operate in a command position effectively at complex incidents, and acquire a better understanding of the requirements and the need for a Unified Command operation. Audience: Officers / Fire & EMS Personnel (12 CEUs for Florida Fire Code Admin, Firesafety Insp. and Instructor I, II & III) 2. (W0455) STRATEGY AND TACTICS FOR INITIAL COMPANY OPERATIONS [STICO] Curriculum: Incident Management. This course is designed to meet the needs of Company Officers (COs) responsible for managing the operations of one or more companies during structural firefighting operations. This course is designed to develop the management skills needed by COs to accomplish assigned tactics at structure fires. Audience: Officers / Senior Firefighters (12 CEUs for Instructor I, II & III) 3. (W0379) FIRE INVESTIGATION: FIRST RESPONDERS Curriculum: Arson. This course is designed specifically to provide a clear definition of the role of the first responder in arson detection. It will provide essential knowledge to enable an individual to recognize the potential of intentionally set fires, how to preserve and protect the evidence, and the proper reporting of information to appropriate officials. By strengthening the partnership between first responders and investigators, the chances for successfully solving arson-related crimes will increase. The course topics will cover fire behavior, critical observations, fire causes, scene security and evidence preservation, legal considerations, and appropriate documentation of the responder s findings. NOTE: Prior to participating in the classroom, registered students are required to complete (Q0379) online at: http://www.usfa.fema.gov/training/nfa/courses/online.html Audience: Fire & Emergency Services Personnel who respond to fires. (CEUs for this course have not been determined at this time)
FLORIDA STATE WEEKEND 2017 REGISTRATION FORM REGISTRATION CLOSING DATE: MARCH 17, 2017 IMPORTANT: This Registration Form as well as the NFA (FEMA) Application Form 119-25-2, (2/12) must be completed FD Chief or their designee must sign the NFA (FEMA) Application Form 119-25-2 (LINE 19a, b, & c) Both forms need to be sent with Purchase Order, or Check payable to NW FL VOL COUNCIL. MAIL both the Registration & NFA (FEMA) Application along with payment to: Florida State Fire College Attn: Angie Cain 11655 NW Gainesville Road Ocala, FL 34482 Name: Telephone: Cell: Address: City/Town: State: Zip: Email: Fire/EMS Position: SELECT YOUR COURSE PREFERENCE: PLACE A #1 BY YOUR FIRST CHOICE, THEN #2, AND #3 BY COURSES BELOW. (PLEASE CHOOSE 3) YOUR COURSE CHOICE IS BASED UPON FIRST COME / FIRST SERVE UNTIL COURSE IS FILLED. W0609 Introduction to Unified Command for All Hazard Incidents W0455 Strategy and Tactics for Initial Company Operations W0379 Fire Investigation: First Responders POLO SHIRT (PLEASE PICK SIZE) MEN S WOMEN S SMALL MEDIUM LARGE X-LARGE 2X 3X POLO SHIRT IS INCLUDED IN REGISTRATION FEE
DEPARTMENT OF HOMELAND SECURITY FEDERAL EMERGENCY MANAGEMENT AGENCY GENERAL ADMISSIONS APPLICATION SHORT FORM See Reverse for Privacy Act Statement O.M.B. No. 1660-0100 Expires November 30, 2016 SECTION I - GENERAL INFORMATION 1. DATE OF BIRTH (Mo, Day, Yr.) 2. GENDER 3. U.S. CITIZEN If No, City and Country of Birth: FEMALE MALE YES NO PERMANENT RESIDENT 4. RACE (Please check all that apply) 1. AMERICAN INDIAN or ALASKAN NATIVE 2. ASIAN 3. BLACK or AFRICAN AMERICAN 4a. ETHNICITY HISPANIC or LATINO 4. WHITE 5. NATIVE HAWAIIAN or PACIFIC ISLANDER NOT HISPANIC or LATINO 5. PLEASE PRINT YOUR NAME (Last, First, Middle, Suffix) 6. STUDENT IDENTIFICATION (SID) NUMBER 7. HOME MAILING ADDRESS (Street, avenue, road no., P.O. box/city or town, and zip code) 8. Work Phone Number: 9. Home Phone Number: 10. FAX Number: 12a. ENTER COURSE CODE AND TITLE 11. E-MAIL ADDRESS 12b. COURSE LOCATION 12c. DATE 13. DO YOU HAVE ANY DISABILITIES (Including special allergies or medical disabilities) WHICH WOULD REQUIRE SPECIAL CONSIDERATION DURING YOUR ATTENDANCE IN TRAINING? NO YES (If yes, indicate & describe any special considerations required on a separate sheet) SECTION II - EMPLOYMENT INFORMATION 14a. NAME AND COMPLETE ADDRESS OF ORGANIZATION BEING REPRESENTED 14b. NFIRS # 15. CURRENT POSITION AND NUMBER OF YEARS IN (NFA ONLY) POSITION 16. CHECK THE BOX(ES) BELOW THAT BEST DESCRIBE YOUR ORGANIZATION 16b. ORGANIZATION 16c. CURRENT STATUS 16a. JURISDICTION 1. PAID FULL TIME. 1. STATEWIDE 4. SPECIAL DISTRICT/TOWNSHIP 7. FOREIGN 1. ALL CAREER 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 SECTION III - ENDORSEMENT AND CERTIFICATION 17a. I certify that the information recorded on this application is correct. Falsification of information will result in denial of a course certificate and stipend (U.S.C. 1001). 17b. 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 officer or designee. 17c. 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. 17d. 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. 18a. SIGNATURE OF APPLICANT 18b. DATE 19. APPROVAL BY THE HEAD OF THE SPONSORING ORGANIZATION (NOT REQUIRED FOR SELF STUDY PROGRAMS) 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. 19a. SIGNATURE 19b. PRINTED NAME AND TITLE 19c. DATE 20. ADDITIONAL ENDORSEMENTS FOR APPLICATION TO THE EMERGENCY MANAGEMENT INSTITUTE (NOT REQUIRED FOR SELF STUDY PROGRAMS) 20a. SIGNATURE AND DATE (State Office) 20b. SIGNATURE AND DATE (FEMA Regional Office) 21. SUBMIT APPLICATION TO APPROPRIATE SPONSOR FEMA Form 119-25-2, (2/12) PREVIOUS EDITION FF75-5A OBSOLETE
22a. DISPOSITION 22b. SIGNATURE OF REVIEWER 22c. 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 studentrelated 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 6 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.