Top 8 Tips For Completing A Successful Nfa Application

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8

Top

Top

Tips for Completing a Successful NFA Application

Tips for Completing a

Successful

NFA Application

#8:

If a prerequisite includes a

DEPARTMENT OF HOMELAND SECURITY

O.M.B. No. 1660-0100

specific certification, we expect

See Reverse for

FEDERAL EMERGENCY MANAGEMENT AGENCY

Expires November 30, 2016

Privacy Act Statement

GENERAL ADMISSIONS APPLICATION

to see a copy of that certifica-

SECTION I - GENERAL INFORMATION

1. U.S. Citizen

If No, City and Country of Birth:

tion attached to the 119-25-1.

YES

NO

PERMANENT RESIDENT

2. NAME (Last, First, Middle Initial, Suffix)

3. STUDENT IDENTIFICATION (SID) NUMBER

If it’s not attached, the applica-

tion package is NOT complete.

4. HOME MAILING ADDRESS (Street, avenue, road no, P.O. box/city or town, state, and zip code)

5. WORK PHONE NO.

6. HOME PHONE NO.

#7:

If a prerequisite includes

7. FAX NO.

an education requirement, we

8. E-MAIL ADDRESS:

expect to see that information

9a. ENTER COURSE CODE AND TITLE: (If you wish to apply for more than one course,

9b. COURSE LOCATION

9c. DATES REQUESTED (Please give three choices)

please attach a sheet of paper to this application)

in Block #10.

10. COMPLETE THE ITEMS BELOW REGARDING THE PREREQUISITES OF THE COURSE FOR WHICH YOU ARE APPLYING

INSTITUTION

DEGREE/CERTIFICATE

DATE EARNED

COURSE/FIELD OF STUDY

#6:

Address the student

11. DO YOU HAVE ANY DISABILITIES (Including special allergies or medical disabilities) WHICH WOULD REQUIRE SPECIAL ASSISTANCE DURING YOUR ATTENDANCE IN TRAINING?

selection criteria completely.

(If yes, describe & indicate any special assistance required on a separate sheet)

YES

NO

This should be done in Block

SECTION II - EMPLOYMENT INFORMATION AND AUTHORIZATION

12a. NAME AND COMPLETE ADDRESS OF ORGANIZATION BEING REPRESENTED

12b. NFIRS #

13. CURRENT POSITION AND NUMBER OF

#16. Keep in mind that this is

(NFA STUDENTS ONLY)

YEARS IN POSITION

where we:

DO

14. CHECK THE BOX(ES) BELOW THAT BEST DESCRIBE YOUR ORGANIZATION

•

want to know what you

14 a. JURISDICTION

14 b. ORGANIZATION

15. CURRENT STATUS

FOREIGN

SPECIAL DISTRICT/TOWNSHIP

PAID FULL TIME

1.

4.

7.

1.

ALL CAREER

STATEWIDE

do that qualifies you for the

1.

PAID PART TIME

2.

ALL VOLUNTEER

2.

5.

8.

DHS/FEMA

2.

COUNTY GOVERNMENT

FEDERAL/MILITARY (non-DHS)

class you are applying for.

VOLUNTEER

3.

CITY/TOWN/VILLAGE

COMBINATION

3.

6.

9.

TRIBAL NATION

3.

INDUSTRY/BUSINESS

DISASTER RESERVIST

4.

DO NOT

•

want to know how

16. Briefly describe your activities/responsibilities as they relate to the course for which you are applying and identify how you will use the information obtained from the course. Attach an

organizational chart for the organization being represented and indicate your position. If you need more space, please attach a sheet to this application.

you think you will benefit

from this class.

17. CHECK ONE BOX IN EACH COLUMN THAT BEST DESCRIBES YOUR PRESENT PRIMARY RESPONSIBILITY AND TYPE OF EXPERIENCE AS IT RELATES TO THE COURSE FOR

WHICH YOU ARE APPLYING. ALSO ENTER THE NUMBER OF YEARS OF EXPERIENCE.

#5:

Take the student selection

17a. PRIMARY RESPONSIBILITY

17b. TYPE OF EXPERIENCE

17c. NUMBER OF YEARS OF EXPERIENCE

criteria from the course catalog

1.

1.

INCIDENT COMMAND

MANAGEMENT

2.

2.

ADMINISTRATION/STAFF SUPPORT

TRAINING/EDUCATION

17d. SIZE OF DEPARTMENT

and repeat it back in Block #16

3.

3.

SUPERVISION

SCIENTIFIC/ENGINEERING

as it applies to your position. For

BUDGET/PLANNING

17e. BUSINESS TYPE

4.

4.

INVESTIGATION

PROGRAM DEVELOPMENT/DELIVERY

1.

5.

5.

GOVERNMENT

example, if the selection criteria

FIRE PREVENTION

COORDINATION/LIAISON

6.

FIRE SUPPRESSION

6.

2.

EDUCATION

calls for a minimum of 36 months

PROGRAM/ACTIVITY

PUBLIC EDUCATION

7.

7.

3.

FIRE SERVICE

experience, the reviewer is look-

HEALTH

8.

8.

CODE DEVELOPMENT

LAW ENFORCEMENT

4.

PUBLIC WORKS

9.

9.

CODE ENFORCEMENT/INSPECTION

ing for a statement indicating that

VOLUNTEER AGENCY

5.

DISASTER RESPONSE/RECOVERY

10.

10.

SUPPORT SERVICES

you have xx months of experience.

EMERGENCY MANAGEMENT

6.

EMERGENCY MEDICAL SERVICE

RESEARCH AND DEVELOPMENT

11.

11.

HEALTH CARE

7.

HAZARD MITIGATION

ARSON

12.

12.

#4:

A Job Description does

PUBLIC WORKS

LAW ENFORCEMENT

8.

13.

EMERGENCY PREPAREDNESS

13.

OTHER

DESIGN AND PLANNING

14.

14.

not tell us what experience you

(Specify)

OTHER (Specify)

15.

have. Tell us what you do in your

19. GENDER

18. DATE OF BIRTH

Male

Female

job that matches the selection

20. RACE (Please check all that apply)

20a. Ethnicity

criteria.

AMERICAN INDIAN or

BLACK or AFRICAN

NATIVE HAWAIIAN or

HISPANIC or

NOT HISPANIC

3.

ASIAN

WHITE

5.

1.

2.

4.

ALASKAN NATIVE

AMERICAN

PACIFIC ISLANDER

LATINO

or LATINO

FEMA Form 119-25-1, (2/12)

PREVIOUS EDITION FF75-5 OBSOLETE

#3:

Don’t forget to attach a

Department organizational

chart showing your position in

SECTION III - ENDORSEMENT AND CERTIFICATION

the organization. Be sure to

21a. I certify that the information recorded on this application is correct. Falsification of information will result in denial of a course certificate and stipend (18 U.S.C. 1001).

circle or highlight your position

21b. I hereby authorize the release of any and all information concerning my enrollment in this course to the chief officer in charge, or designee, of my organization. All requests for information

on the chart so it stands out.

shall be in writing from said chief or designee.

21c. Further, I understand that the National Emergency Training Center (NETC), the Mt. Weather Emergency Operations Center (MWEOC), and the Noble Training Facility (NTF) are not

authorized to provide medical or health insurance for students. I maintain appropriate insurance on an individual basis.

#2:

SIGN YOUR APPLICATION!

21d. I agree to abide by the rules, policies, and regulations of NETC, MWEOC, and NTF. Failure to do so will result in denial of the student stipend, expulsion from the course, and possible barring

from future National Fire Academy (NFA) and Emergency Management Institute (EMI) courses.

Missed signatures are common,

SIGNATURE OF APPLICANT

DATE

and while that error is correct-

able, it still takes time and the

22. APPROVAL BY THE HEAD OF THE SPONSORING ORGANIZATION

applications fall into a pending

"By signing this application, I certify that my organization does not discriminate on the basis of age, gender, race, color, religious belief, national origin, economic status, or disability in providing

educational opportunities for its employees."

category until such time as a

22a. SIGNATURE

22b. PRINTED NAME AND TITLE

signature is forwarded.

23. ADDITIONAL ENDORSEMENTS FOR APPLICATION TO THE EMERGENCY MANAGEMENT INSTITUTE:

23a. SIGNATURE AND DATE (State Office)

23b. SIGNATURE AND DATE (FEMA Regional Office)

#1:

MUST BE COMPLETE

The most important thing to remember is that your application

before it can be processed.

24a. FOR NFA REGIONAL DELIVERY COURSES AND COURSES

24b. FOR EMI COURSES DELIVERED AT NETC, MWEOC, OR NTF

DELIVERED AT EMMITSBURG, MD. SUBMIT APPLICATION TO:

SUBMIT APPLICATION THROUGH THE APPROPRIATE STATE

EMERGENCY MANAGEMENT COORDINATOR OR FEMA REGIONAL

TRAINING MANAGER TO NETC.

NATIONAL EMERGENCY TRAINING CENTER

OFFICE OF ADMISSIONS, BLDG. I-216

16825 SOUTH SETON AVENUE

24c. FOR FIELD PROGRAM COURSES, SUBMIT APPLICATION TO

EMMITSBURG, MD. 21727

APPROPRIATE SPONSOR.