Grant Application

Grant Application
Thank for your interest in online training for your Fire Department. Please fill out all information as accurate as possible
so we can better tailor a training program based around the unique requirements of your department.
*All fields are required for your application to be considered for the grant program.
*To ensure your data is not lost please do not use your browser's back button.

Fire Department Information:

Department Name:

Address:

City:

State:

ZIP:

Phone (xxx-xxx-xxxx): Extension:

Federal Tax ID Number:
(xx-xxxxxxx)
*May also be referred to as
Employer ID Number (EIN)
*For more information on
Federal Tax ID Numbers or how
to obtain one please click here. -

Department Characteristics:

Type of Department:

Volunteer Combination Career

How many active Volunteer personnel:

How many active Career/Paid personnel:

How many Stations in the department:

Types of Services Offered: Structural Fire Suppression
Wildfire Suppression
Hazmat Operational
Rescue Operational
EMS Services
Heavy Rescue

Applicant Contact Information:

First Name:

Last Name:

Title:

Phone (xxx-xxx-xxxx): Extension:

Email:

Training Chief / Officer Contact Information:

First Name:

Last Name:

Title:

Phone (xxx-xxx-xxxx): Extension:

Email:

Department Chief Contact Information:

First Name:

Last Name:

Title:

Phone (xxx-xxx-xxxx): Extension:

Email:

City / Non-Fire Contact Information:

First Name:

Last Name:

Title:

Phone (xxx-xxx-xxxx): Extension:

Email: