THIS FORM IS TO BE USED BY INDIVIDUALS WISHING TO ATTEND ANY VIRGINIA DEPARTMENT OF FIRE PROGRAMS
SPONSORED SCHOOL. PLEASE FILL OUT COMPLETELY UNLESS INDICATED OTHERWISE.
VDFP
Department Address (include zip code)
I certify that the information recorded on this application is correct. I agree to abide by the rules, policies, and regulations of the Virginia Department of Fire Programs and the
host facility, if I am admitted as a student. Falsification of information may result in denial of course attendance or a course certificate. I hereby authorize the release of any and
all information concerning my enrollment in this course. Further, I understand that the Virginia Department of Fire Programs is not authorized to provide medical or health
insurance for students. I maintain appropriate insurance on an individual basis.
Date
Applicant Signature
Home Phone NumberHome Address (include zip code)
Department
FDID #
Are you an
American Citizen?
Yes No
Are you a Virginia
resident?
Yes No
Rank or Title
Last 4 SSN Adjunct Number
Department Telephone Number
If representing a Volunteer Fire Company, name of employer and number you can be reached during the day
Years of Investigative experience
Highest level of NFPA Certification
Years of Fire fighting experience Years of Law Enforcement experience
VolunteerCareerCombination
Virginia Department of Fire Programs’ Student Application
VDFP USE ONLY
Student #
School #
Paid amt / P. O.
Please complete form and submit to the appropriate VDFP Division Office for processing
VolunteerCareer
Please print your name as you wish it to appear on your certificate, FIRST, MI, LAST
Do you have any physical impairments?
If so check block and explain below
in BLOCK A
Circle the number that reflects the highest level of your formal education:
High School 9 10 11 12 College 13 14 15 16
Date of Birth
Male
Female
FIRST COURSE PREFERENCE LIST COURSE NAME & LOCATION DATE OF COURSE FEE
SECOND COURSE PREFERENCE LIST COURSE NAME & LOCATION DATE OF COURSE FEE
THIRD COURSE PREFERENCE LIST COURSE NAME & LOCATION DATE OF COURSE FEE
Additional information BLOCK A
