For Office Use Only:
Date Received: Date Verified:
LSU Carrol L Herring Fire and Emergency Training Institute
Certification Program
Application for Reciprocity
Reciprocity is only given to current Louisiana Fire Department personnel
Applicant's Full Name:______________________________________________________________________
Home Address:_________________________________________City & State:________________________
Zip Code:_______________________Contact Phone Number:_____________________________________
Social Security Number:_________ - _______ - __________ Date of Birth:___________________________
International Fire Service Accreditation Congress/Proboard Information
Requested Level of Certification:_____________________________________________________________
IFSAC/Proboard Entity Granting Certification:_________________________________________________
Date of Certification:________________________IFSAC/Proboard Seal Number:____________________
I am a member of the: __________________________Fire Department in: ____________________ Parish
I hereby declare that the information on this application for reciprocity is true and correct. I have
included a photocopy of the original IFSAC/Proboard certificate if available, indicating the
IFSAC/Proboard seal number as well as all official signatures. I understand that, if my application is
accepted and approved, receiving a reciprocity certificate means that the Louisiana Firefighter and
Emergency Response Certification Program recognizes the previously obtained seal, they will not issue a
new seal. Furthermore, I wish to establish Reciprocity for the above mentioned level of Certification.
______________________________________________ _____________________________
Applicant Signature Date
Reciprocity Certificates are $30.00 each. If requesting more than one certificate, please use a separate
application for each. Please allow 2-3 weeks for processing.
METHOD OF PAYMENT
Check/Money Order (Payable to LSU FETI)
Credit/Debit Card
Please return form and payment to:
LSU Carrol L Herring
Fire & Emergency Training Institute
Certification Office
6868 Nicholson Dr.
Baton Rouge, LA 70820
Telephone: 225-334-6282
Fax: 225-334-6065
Email: feticert@lsu.edu 6/2016
* For security purposes, we will contact you via phone
to obtain card information. Please provide the
following contact information:
Contact Name: _________________________
Contact Phone Number: __________________
