Fillable Basic Firefighter Training (BFT) Training Authorization to Invoice (Mitchell Community College)

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Basic Firefighter Training (BFT) Training Authorization to Invoice (Mitchell Community College)

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MCC-825 Equal Opportunity College/Affirmative Action Employer Rev. 07/18
Basic Firefighter Training (BFT) Training
Authorization to Invoice and Affiliation Certification
Date _______________________________________________________________
Mail Invoice _______________________________________________________ Email Invoice _______________________________________________
Agency Name _____________________________________________________________________________________________________________________
Address ___________________________________________________________________________________________________________________________
City/State/Zip
Phone _____________________________________________________________ Fax __________________________________________________________
Class Title _______________________________________________________________________ Class Date _____________________________________
The person(s) listed below are affiliated with (agency name) ________________________________________________________________
and are in good standing with this agency. We agree to pay 100 % of the following:
Tuition/Registration Fees Books Supplies/Uniforms
1.
5.
2.
6.
3.
7.
4.
8.
Printed Name/Title of Agency Representative ___________________________________________________________________________________
I understand that I am responsible for all charges of the student(s) listed above for the semester/class indicated. I also
understand that, should the student fail to complete the courses approved above, I am still responsible for all charges.
Authorizing Signature _____________________________________________________________ Date ______________________________________
MITCHELL COMMUNITY COLLEGE USE ONLY
CIS# ________________________________________________________________________________
GL/Budget Code __________________________________________________________________________________________________________________
Continuing Education Center Mooresville Campus
701 West Front Street 219 North Academy Street
Statesville, NC 28677 Mooresville, NC 28115
(704) 878-3320 phone (704) 663-1923 phone
(704) 878-4271 fax (704) 663-5239 fax
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Basic Firefighter Training (BFT) Training Authorization to Invoice (Mitchell Community College)

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Completed 26 July 2020

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