Fillable le edb Tobecom anization. FACILITY/PROPUSEAPPLICATION or uestin there (Bucks County Community College)

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le edb Tobecom anization. FACILITY/PROPUSEAPPLICATION or uestin there (Bucks County Community College)

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BROWSE BUCKS COUNTY COMMUNITY COLLEGE FORMS

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Bucks County Community College

Department of Public Safety Training and Certification

1760 South Easton Road

Doylestown, PA 18901

Ph: 215.340.8417

Fax: 215.343.6794

www.bucks.edu/publicsafety

Last Revised: January 01, 2010

FACILITY/PROPUSEAPPLICATION

ThisformmustbesubmittedtotheBucksCountyCommunityCollege–DepartmentofPublicSafetyTraining&CertificationFacilityOperations

Departmentatleast4weeksleadtimebeforeproposedstartingdate.



Tobecom

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there

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or

anization.

Purpose/CourseTitle: Hours Needed: FacilityUseOnly:

 FSC100.______

StartingDate:  EndingDate: 

StartingTime:  EndingTime: 

Indicateanyadditionaldate/timesthisFacility/Propusewillmeetorbeneeded:

[]ScheduleAttached

[]N/A

ECTION2:OrganizationName,AddressandContactPerson:

ContactPerson:  DayTelephoneNo:

OrgName:  EveningTelephoneNo.:

Address1:  MobileTelephoneNo:

Address2:  FaxNumber:

City,State,Zip:  E‐mailAddress:

ECTION3:FacilityAddressorLocationPropwillbeusedat:

Location(includeStreet,City,State,Zip): SponsoringAgency&PrimaryInstructorName

BCPSTC,1760S.EastonRoad,Doylestown,PA18901



ECTION4:FacilityRoomorPropthatisbeingrequested:

Facilityroomsandpropscannotbeguaranteedbyfillingoutthisform. PleasecontacttheOperationsDepartmentforavailability.

PreferredFacilityRoom(s): Props,Equipment,TrainingArea:

Classroom(upto40seats): []201[]202[]203 TrainingTower: []Yes

[]NoRoomPreference []104[]105 []106 ExtricationArea: []Yes

Auditorium(upto80seats): []201/202 LiveFireBurnProp: []Yes

Specificroomneedspleaseindicatetrainingneeds:  Extinguisher(Bullex)Prop#1: []Yes

VehicleFire(mobile)Prop#1: []Yes

[]LCDprojector[]Computer[]InternetAccess

[]Microphone[]Video/DVD[]Microphone

ForcibleEntry(mobile)Prop#1: []Yes

ConfinedSpaceRescueArea: []Yes

Equipment/Trainingareanotlistedonthisform:(bespecific): BleacherArea: []Yes

 HazMatArea: []Yes

CafeteriaArea:[]YES[]NO

Purpose:[]Lunch/Breaks[]Testing[]Registration 

[]Other___________________________________________

TrenchProp:

[]Yes

FlammableLiquidsPad: []Yes

 

ECTION5:

ignatureofRequestingAgency:

RequestingPerson:  Signature: 

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Completed 3 October 2020

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