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➢
Completed Application for Admission
(submitted online)
➢
Signed Criminal History Disclaimer (submitted online)
➢
Completed by Physician: General medical physical by physician (This may be emailed to
kcfa@kilgore.edu.)
➢
Copy of High School Diploma or GED
(This may be emailed to kcfa@kilgore.edu.)
➢
PPE Release if providing own gear. This form will need to be notarized. (This may be emailed to
kcfa@kilgore.edu.)
➢
Proof of Bacterial Meningitis vaccination
for those under 22
. (This may be emailed to
kcfa@kilgore.edu.)
Canadian students will a
lso need to submit:
➢
Completed I-20M Immigration Information form (submitted online)
➢
Copy of passport photo page for identification purposes (This may be emailed to kcfa@kilgore.edu.)
Tuition should be paid by the Monday (one week) before class begins. The student may decide three weeks before
the onsite skills training if they will need to rent bunker gear (if not, then provide PPE Release form), stay on
campus at the bunk house, and pay for the added expense.
*Information Pa
ge
Fire Academy
ALL STUDENTS: Before filling out the application, you will first need to request your FIDO pin number.
FIDO is the record keeping system the Texas Commission on Fire Protection uses to keep up with your
certifications. Your FIDO number is very important in the Fire Service. Please write it down and keep up with
it. It is your identification number for TCFP. You may click here to begin the process.
Click on the FIDO link on the top, right side of the page. Under Individuals, click on the box Create FIDO
Account. Follow the steps. Be sure and use a current, valid email address that you can easily access. Your
pin# will be sent to that email address. Check your email for the pin#. You should receive your FIDO
number. Keep up with that number. When you need to access FIDO in the future go to
http://www.tcfp.texas.gov/.
When you are ready to apply to the Kilgore College online or onsite Basic Fire Suppression program,
download this packet to Adobe, fill out the Application and Criminal History Disclaimer below, save the
packet, and submit it via email to kcfa@kilgore.edu. The Canadian student’s application packet also includes
the I-20M form that is also to be submitted online. You should be able to type your information on the form
while in Adobe, save it, and email it. The Physical, copy of your High School Diploma/GED, PPE Release
form, and proof of bacterial meningitis vaccination forms will need to be scanned (or you may take a picture
of them) and emailed to kcfa@kilgore.edu.
Payment may be made after we have registered you in the class. We will notify all applicants when they have
been registered and may begin paying their tuition.
The Kilgore College Fire Academy requires the applicant to provide proof
of the following:
Canadian Application for Basic Fire Suppression
(first step to becoming a certified firefighter in Texas and applying for IFSAC seals)
Academy applying for:
Social Security #: TCFP/FIDO #:
Email Address:
Name:
(First) (MI) (Last)
Address:
(Street or PO Box)
(City) (Province) (Postal Code) (Country)
Phone:
Emergency Contact:
(
Name) (Phone)
(City)
(Province)
(Country)
Date of Birth:
City/Province/Country of Birth:
Gender:
Male
Female
U.S. Citizen:
Yes
No
Are you Hispanic or Latino? (Are you a person of Cuban, Mexican, Puerto Rican, South or Central
American, or other Hispanic culture or origin?)
Yes
No
Please select the racial category with which you most closely identify:
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
For Internal Use Only
KC ID #:
Fire Academy
Not Applicable
Class #:
Class Dates:
Please select which applies:
First time at any post-secondary institution
Not first time in a post-secondary institution
Highest level of education:
GED
High School Diploma
Associates Degree
Higher Degree received
Have you served or volunteered with any type of fire department/EMS service?
Yes
No
If so, then where?
Are you a(n):
EMR
EMT
Paramedic
No
From what source did you learn about the Kilgore College Fire Academy?
Internet search
Kilgore College website
Kilgore College Facebook page
KC Fire Academy Facebook page
Commercial
Previous student
Other:
CERTIFICATION:
I certify that the above answers are true, complete, and correct to the best of my knowledge. I further certify that I am, to the
best of my knowledge, free from any medical condition which would prohibit me from participating in all activities connected
with the Skills Session portion of the Academy.
Today’s date
Full legal name and last four digits of driver’s license
Fire Academy
INTERNATIONAL STUDENTS ONLY
International Students MUST also provide the Academy with a
copy of their passport page
documenting their
identification. Send the copy of the passport page to kcfa@kilgore.edu.
All students entering the United States to study must receive from Kilgore College an original I-20M1
Certification of Eligibility form
SIGNED IN BLUE INK
. We will send this to you after you have completed this
form and sent us a copy of your passport page.
Kilgore College Fire Academy I-20M1 Immigration
Information
(To Be Completed by Out-of-Country Students
ONLY)
Country of Citizenship:
Date of Birth:
Last Name (as on Passport):
First & Middle
(as on Passport):
Country of Birth:
Telephone No.:
E-Mail:
Education Level:
Mailing Address:
Course Fees: Living Expenses:
TOTAL:
Method of Payment:
Credit/debit card, cashier's check, certified check, or money order ONLY [in U.S. dollars only]
Entity/person issuing
payment - self, sponsor, etc.
Start Date:
Completion Date:
First Name as on passport
Middle Name if on passport
Fire Academy
(Street or PO Box)
(City) (Province)
The following information refers to estimated expenses while attending the on-site Skills Session training:
(Postal Code)
Kilgore College Fire Academy
TCFP Criminal History Disclaimer
The Texas Commission on Fire Protection's Rules and Regulations governs the criteria for state certification of a
firefighter. There are circumstances under which the Texas Commission on Fire Protection (TCFP) may
DENY
certification to an individual who has been convicted of criminal offenses. If you have been convicted of any felony
offense or any misdemeanor class "B" or above, it is your responsibility to determine whether or not the TCFP will
issue you a certification. The most effective way to do this is by submitting to TCFP an APPLICATION FOR EARLY
REVIEW OF CERTIFICATION, which is available at the following URL:
https://www.tcfp.texas.gov/Services/GetPdf?filename=%2FForms%2FTCFP-012.pdf
Applicants are not obligated by Kilgore College to obtain this early review, but it is STRONGLY RECOMMENDED
that it be done if the applicant has any convictions above the level of class "C" misdemeanor.
I, (the Applicant) have read the above statement regarding the Texas Commission on Fire Protection Criminal History
Disclaimer and understand the information contained therein.
Applicant Name and last four digits of driver’s license Date
Fire Academy
*Please print this page and the next page. Your physician will need to fill it out and sign it. This page may be scanned/emailed
to kcfa@kilgore.edu or mailed to
: Kilgore College Fire Academy, ATTN: Kristi Simpson, 1100 Broadway, Kilgore, Texas 75662
FIREFIGHTER MEDICAL EXAMINATION CERTIFICATE
Last Name: First: Middle:
Date of Birth: Social Security #:
Address:
(City)
(Province)
(Postal Code)
I certify that I have completed my examination of the examinee and I have concluded that on this date, the
examinee has had:
□ PHYSICAL EXAM
And is to be found physically sound and free from any defect which may adversely affect the performance of duty
appropriate to the type of license sought. (See attached Overall Strengths Demands Required for Firefighters)
Passed
Failed
Physician
Information:
Name
License Number
City
Province
Postal Code
Mailing
Address:
(Street)
Office Phone Number:
Date Signature of Physician
This declaration is not public information and is valid unless withdrawn or invalidated, and is valid only if signed
by a licensed physician.
Fire Academy
Not Applicable
Overall Strength Demands Required for Firefighters
The following criteria are descriptions of the overall strength demand requirements that firefighters are medically
and physically capable to perform.
PHYSICAL DEMAND
Standing/Walking
Vision
Hearing/Talking
Lifting/Carrying
ladders up to 24 feet long (64 lbs.); fan (50 lbs.); fire extinguisher (40-45
Pushing/Pulling
Reaching
60 inches; for fire extinguishers – 20 inches; for deluge gun – up to 80
inches; for extension ladder – 72 inches; for Hurst tool and power unit – 42
Handling
Fine Dexterity
Foot control
Bending
Twisting
Climbing/Balancing
Machines, Tools, Equipment and Work Aids
Chain saws, smoke ejectors, generators, self-contained breathing apparatus, fire pumps, nozzles, axes, pike
poles, ladders, ropes, Hurst tool and power unit, hoses, deluge gun, halligan tool, stretcher, oxygen, electrical
cords, spanner wrench, emergency medical equipment, and hydrant wrench and computer.
Environmental Factors
Exposed to extreme heat in burning structures; work outside in all types of weather and high humidity.
Exposed to chemicals, exhaust fumes, smoke, burning buildings, noise from truck engines, jaws and power
units, saws, sirens and air horns. Operate power saws, jaws, and power unit tool.
*Information Page
Fire Academy
Additional Requirements for Canadian Students
The Commission now has a rule in place that will allow any Canadian student with documented proof of successful
completion of at a minimum the British Columbia Occupational First Aid Level 3 or Alberta documentation of the First
Responder Level III to have met the Texas medical equivalency of the E.C.A. or the Red Cross Emergency Response
course required to fulfill the Commission’s medical requirements. Agencies in your Providence may require a higher
level of medical training for employment. It is your responsibility to verify this information where you are wishing to
be employed. You must meet the Commission’s medical requirement in order to obtain your IFSAC seals. For questions
regarding if your medical certification is acceptable, you must contact Joyce Guinn
at the Texas Commission on Fire
Protection (512) 936-3815.
All Canadian students MUST process through the Immigration and Naturalization Service (INS) counter at their point
of exit from Canada or at their point of entry into the U.S.
•
ONLINE STUDENTS:YOU WILL RECEIVE AN ORIGINAL,
SIGNED IN BLUE INK
, I-20M1 FORM
FROM KILGORE COLLEGE FIRE ACADEMY VIA MAIL. IT IS SENT TO YOU ONCE PAYMENT IS
RECEIVED AND IT IS YOUR RESPONSIBILITY TO NOTIFY US WHEN YOU RECEIVE THE FORM.
•
ONSITE STUDENTS:THE ORIGINAL
SIGNED IN BLUE INK
I-20M1 FORM IS SENT TO YOU WITH
YOUR ACCEPTANCE LETTER AND IT IS YOUR RESPONSIBILITY TO NOTIFY US WHEN YOU
RECEIVE THE FORM.
ANY ADDITIONAL I20M1 FORM THAT HAS TO BE RE-PRINTED AND SENT WILL COST YOU AN
ADDITIONAL $50. If the student’s I-20M1 form is not properly processed by Immigrations personnel, the student may
be sent home OR turned away at the border.
Payment must be made by credit card, cashier’s check, certified check, or money order ONLY (in U.S. dollars only). An
additional $15.00 should be added to each of the above to cover international bank processing charges.
IFSAC Seals:
Examinees that pass the Commission’s Basic Structural Fire Suppression certification exam are eligible for four
International Fire Service Accreditation Congress seals (IFSAC Seals): Fire Fighter I, Fire Fighter II, Hazardous
Materials Awareness and Hazardous Materials Operations as long as they achieve a score of 70% or higher on each of
the four (4) exam sections. If a student fails a particular exam section, they would not be eligible for the seal in that area
that he or she failed. The Fire Commission has broken the written exam into the following four (4) sections:
1. Fire Fighter I
175 questions
between FF1 & FFII
70% minimum pass rate
2. Fire Fighter II
70% minimum pass rate
3. Haz-Mat Awareness
25 questions
70% minimum pass rate
4. Haz-Mat Operations
25 questions
70% minimum pass rate
The student must pass each of the four sections with a minimum of 70% on each section to qualify for the four (4)
IFSAC seals.
The Texas Commission on Fire Protection will NOT send certification tests out-of-state or out-of-country. All initial
and make up tests will be administered in Texas at an approved test site. For further information regarding this ruling,
contact
Joyce Guinn
at the Texas Commission on Fire Protection 512.936.3815.
*Information Page
Fire Academy
BACTERIAL MENINGITIS VACCINATION
Effective September 1, 2013, state law requires that entering students who are younger than 22 years of age and
who are attending any public, private, or independent institution of higher education must provide that
educational institution with proof of immunization against bacterial meningitis within the five years prior to
enrollment. The student must provide this documentation no later than 10 days prior to the beginning of the class.
For purposes of this new law, “entering student” means either a student who has never attended a class at the
educational institution or a student who previously attended an institution of higher education before 1/1/12, and
who is enrolling in the same or another institution of higher education following a break in enrollment of at least
one fall or spring semesters.
There exist limited exceptions to this law based on legitimate religious or medical objections; please contact the
Office of the Registrar (903.983.8200) for additional information.
There are two types of bacterial meningitis vaccines that are acceptable. They may be listed by full vaccine
name, brand name, or abbreviation on students’ shot records. A student’s shot record must list one of the
following within the last five years to meet the bacterial meningitis vaccination requirement:
Meningococcal polysaccharide vaccine:
Menomune or MPSV4
Meningococcal conjugate vaccine:
Menactra or Menveo or MCV4
*Information Page
Fire Academy
*If the student is providing their own PPE through a fire department, the form below must be filled out and returned before
the onsite class begins or at least three weeks before the onsite skills training begins for the online class begins. This page
may be scanned/emailed to kcfa@kilgore.edu or mailed to: Kilgore College Fire Academy, ATTN: Fire Academy, 1100
Broadway, K
ilgore, Texas 75662
**(Online Class) A rental form will be sent to all students six weeks prior to the Skills Training class beginning.
PPE RELEASE
As Fire Chief of the Fire Department, I do hereby verify that
is a member of our fire department or associated with our department. Due to his membership
or association with our fire department, I do hereby acknowledge that our fire department is issuing and making
available a full set of personal protective clothing for use for Structural Firefighter Training at the Kilgore College Fire
Academy, Kilgore, Texas. The full set of personal protective clothing shall consist of firefighting boots, pants, coat,
suspenders, hood, helmet with shield or goggles, and gloves. Each and every set of protective clothing that will be used
during the course of instruction for a commission approved fire protection personnel curriculum shall comply with
TCFP §435.1 of this title (relating to Protective Clothing).
I attest that all protective clothing which is used by fire protection personnel assigned to fire suppression duties comply
with the minimum standards of the National Fire Protection Association suitable for the tasks the individual is expected
to perform. The National Fire Protection Association standard applicable to protective clothing is the standard in effect
at the time the entity contracts for new, rebuilt, or used protective clothing; and maintain and provide upon request by
the Commission, a departmental standard operating procedure regarding the use, selection, care, and maintenance of
protective clothing which complies with NFPA 1851, Standard on Selection, Care, and Maintenance of Structural Fire
Fighting Protective Ensembles.
As Fire Chief of this organization I do hereby verify that this equipment does comply with all requirements as
established by the Texas Commission on Fire Protection regarding NFPA 1851. I further verify that upon request by
Kilgore College Fire Academy, Texas Commission on Fire Protection, or any other authority having jurisdiction, I shall
produce written documentation that all components of this equipment do meet all NFPA standards regarding
inspection, cleaning, and documentation.
Kilgore College Fire Academy will inspect the equipment you have issued to the above-named individual. If any of the
equipment does not pass inspection, your department will either have to issue additional equipment immediately or the
student will be required to rent approved PPE from our agency or agent.
Dated this day of , 20 .
Signature
AFFIDAVIT
STATE of , COUNTRY of , COUNTY or PROVINCE of .
BEFORE ME, the undersigned authority, on this day personally appeared ,
known to me who, being by me duly sworn, upon oath deposes and states that he/she is over the age of eighteen (18)
years of age, that he/she is fully competent to make this release, indemnity, and hold harmless agreement, that he/she
has personal knowledge of the statements contained in the above, that the statements contained in the above instrument
are true and correct, and that he/she executed the above instrument for the purposes and consideration therein expressed
SUBSCRIBED AND SWORN TO before me and given under my hand and seal of office this day of
, 20 .
My commission expires
Notary Public
Fire Academy
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Completed 6 October 2020

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