Fillable Department of Fire Services - Training Program Request For Credential Credit Application

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Department of Fire Services - Training Program Request For Credential Credit Application

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030119
Department of Fire Services
Massachusetts Firefighting Academy
TRAINING PROGRAM REQUEST FOR CREDENTIAL CREDIT APPLICATION
All requests for credential credit MUST be submitted on this application.
All trainings
must be associated with fire service activities, functions or organizations.
This application:
• Is re
quired for trainings that do not appear on the Approved Training List or challenging an existing course’s credit
• Can be submitted pre or post training date
• Can be submitted by the Training Coordinator, Instructor, Speaker, Student or Attendee
On
ce submitted, it will be evaluated within 7 business days and the original submitter will be contacted with the
application status via email.
If the training is awarded credit, it will be added to the Approved Trainings List with an Approval # and then can be
included within the Professional Development section of an Applicant’s main credential application.
A COMPLETED APPLICATION INCLUDES:
Training Program Request for Credential Application
A course syllabus or detailed outline including the specific Job Performance Requirements (JPRs) addressed within
the appropriate NFPA standard attached.
Sponsoring Organization_____________________________________________________________________________
Training Program Name___________________________________________________________________________________
Start Date ________________ End Date________________ Start Time _________ End Time _________
Total Hours (Not Including Breaks) ________________
Program Location
Address ____________________________________________________________________________________________________
City, State, Zip ______________________________________________________________________________________________
Program Coordinator or Applicant
Contact Name ________________________________________________________________________________________________
Daytime Phone _____________________________Email_____________________________________________________________
The Applicant hereby affirms that the information on this application is true and correct and that the course will conform to the standards set forth in
the attached outline.
SignDate___________________________________________________
HARD COPY APPLICATIONS WILL NOT BE ACCEPTED
Submit Completed Applications to:
DFS.credentialing@mass.gov
click to sign
signature
click to edit
Fire Service Commission
Fire Chief Credentialing
Job Performance Requirements (JPRs)
A detailed outline/syllabus must be submitted along with this application to verify time allocated on each JPR.. Check all JPRs that apply.
NFPA Standard 1021 Fire Chief Credential (FCC/FCRC)
4.2.1 4.2.2 4.2.3 4.2.4 4.2.5 4.2.6
4.3.1 4.3.2 4.3.3
4.4.1 4.4.2 4.4.3 4.4.4 4.4.5
4.5.1 4.5.2 4.5.3
4.6.1 4.6.2 4.6.3
4.7.1 4.7.2 4.7.3
5
.2.1 5.2.2 5.2.3
5.3.1
5.4.1 5.4.2 5.4.3 5.4.4 5.4.5 5.4.6
5.5.1
5.6
.1 5
.6.2 5.6.3
5.7.1
Total Hours (Addressing the Above JPR’s Chapters 4&5) ________________
6.2.1 6.2.2 6.2.3 6.2.4 6.2.5 6.2.6 6.2.7
6.3.1
6.4.1 6.4.2 6.4.3 6.4.4 6.4.5
6.5.1 6.5.2
6.6.1 6.6.2 6.6.3
6.7.1
6.8.1
7.2.1 7.2.2 7.2.3 7.2.4 7.2.5
7.3.1
7.4.1 7.4.2 7.4.3 7.4.4
7
.5.1
7.6.1 7.6.2
7.7.1
Total Hours (Addressing the Above JPR’s Chapters 6&7) _______________
NFPA Standard 1031 Fire Prevention Officer Credential (FPO)
4
.2.1 4.2.2 4.2.3 4.2.4 4.2.5 4.2.6
4.3.1 4.3.2 4.3.3 4.3.4 4.3.5 4.3.6 4.3.7
4.3.8 4.3.9 4.3.10
4.3.11 4.3.12 4.3.13 4.3.14
4.3.15 4.3.16
4.4
Total Hours (Addressing the Above JPR’s Chapter 4) ________________
5.2.1 5.2.2 5.2.3 5.2.4
5.3.1 5.3.2 5.3.3 5.3.4 5.3.5 5.3.6 5
.3.7
5.3.8 5.3.9 5.3.10
5.3.11 5.3.12
5.4.1 5.4.2 5.4.3 5.4.4 5.4.5 5.4.6
Total Hours (Addressing the Above JPR’s Chapter 5) ________________
Department of Fire Services
Fire Prevention Officer Credentialing
Link For Your Reference:
NFPA 1021 Standard
Link For Your Reference:
NFPA 1031 Standard
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Department of Fire Services - Training Program Request For Credential Credit Application

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Completed 15 May 2020

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