Kilgore College Fire Academy Fire Inspector I, II or Plans Examiner Registration Form (rev. 4/10/16)

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1 SSN: KC ID: FIDO# (SSN Used to create KC ID#) (If Previous Student and know KC ID #) (Needed to Submit TCFP Rosters) NAME: (LAST) (FIRST) (MI) STREET ADDRESS: CITY: STATE: ZIP: Home Phone: Cell Phone: County of Residence: AGENCY: Gender: (M or F) DOB: / / Are you a U.S. Citizen? (Y or N) MM DD YYYY Are you Hispanic or Latino? (Are you a person of Cuban, Mexican, Puerto Rican, South or Central America, or other Spanish culture or origin, regardless of race?) Yes No Please select the racial category or categories with which you most closely identify. Check as many as apply: American Indian or Alaskan Native Asian White Black or African American Native Hawaiian or Other Pacific Islander International or Non-Resident COURSE TITLE: Start Date: Skills Dates: #of Hours: Students must be complete with all on-line course work one week prior to set skills session associated with the date enrolled. Student must also confirm by intent to attend said skills session in order to be placed on a Skills Roster. FAILURE to either complete the on-line course work or notify by intent to attend skills one week prior to skills session will result in not being eligible for skills, not placed on skills roster, and non-completed from the course. COURSE FEE: $ Method of Payment: I certify that the information on this application is complete and correct. I further certify that in the event that there are any financial holds placed on me by Kilgore College, I understand I will not be able to register for this course. SIGNATURE: DATE: TCFP Course Approval: (To Be Completed by Kilgore College Fire Academy)

2 Fire Inspector I (with Skills) 90 hours (include skills 1 day) ID# On-Line Dates Skills (Tues.) Fee Out-of-State /1/16-1/10/17 01/10/17 $ $ /1/16-1/10/17 01/10/17 $ $ /1/17-2/7/17 02/07/17 $ $ /1/17-2/28/17 02/21/17 $ $ /1/17-4/11/17 4/11/2017 $ $ /1/17-5/9/17 5/9/2017 $ $ /1/17-6/6/17 6/6/2017 $ $ /1/17-7/11/17 7/11/2017 $ $ /1/17-8/8/17 8/8/2017 $ $ /1/17-9/12/17 **9/12/2017 $ $ /1/17-10/3/17 10/3/2017 $ $ /1/17-11/7/17 11/07/17 $ $ /1/17-1/9/18 01/09/18 $ $ /1/17-1/9/18 01/09/18 $ $300.00

3 Fire Inspector II - 70 Hrs includes 2 day skills ID# On-Line Dates Skills (Tues. & Wed.) Fee Out-of-State /1/16-1/11/17 1/10/17-1/11/17 $ $ /1/16-1/11/17 1/10/17-1/11/17 $ $ /1/17-2/8/17 2/7/17-2/8/17 $ $ /1/17-3/1/17 2/21/17 2/22/17 $ $ /1/17-4/12/17 4/11/17-4/12/17 $ $ /1/17-5/10/17 5/9/17-510/17 $ $ /1/17-6/7/17 6/6/17-6/7/17 $ $ /1/17-7/12/17 7/11/17-7/12/17 $ $ /1/17-8/9/17 8/8/17-8/9/17 $ $ /1/17-9/13/17 **9/12/17-9/13/17 $ $ /1/17-10/4/17 10/3/17-10/4/17 $ $ /1/17-11/8/17 11/7/17-11/8/17 $ $ /1/17-1/10/18 1/9/18-1/10/18 $ $ /1/17-1/10/18 1/9/18-1/10/18 $ $300.00

4 Plans Examiner I with Inspector I & II (1 Day Skills) ID# On-Line Dates Skills (Wed.) Fee Out-of-State /1/16-1/11/17 01/11/17 $ $ /1/16-1/11/17 01/11/17 $ $ /1/17-2/8/17 02/08/17 $ $ /1/17-3/1/17 02/22/17 $ $ /1/17-4/12/17 4/12/2017 $ $ /1/17-5/10/17 5/10/2017 $ $ /1/17-6/7/17 6/7/2017 $ $ /1/17-7/12/17 7/12/2017 $ $ /1/17-8/9/17 8/9/2017 $ $ /1/17-9/13/17 **9/13/17 $ $ /1/17-10/4/17 10/4/2017 $ $ /1/17-11/8/17 11/08/17 $ $ /1/17-1/10/18 01/10/18 $ $ /1/17-1/10/18 01/10/18 $ $300.00

5 Plans Examiner I without Inspector I & II (1 Day Skills) ID# On-Line Dates Skills (Wed.) Fee Out-of-State /1/16-1/11/17 01/11/17 $ $ /1/16-1/11/17 01/11/17 $ $ /1/17-2/8/17 02/08/17 $ $ /1/17-3/1/17 02/22/17 $ $ /1/17-4/12/17 4/12/2017 $ $ /1/17-5/10/17 5/10/2017 $ $ /1/17-6/7/17 6/7/2017 $ $ /1/17-7/12/17 7/12/2017 $ $ /1/17-8/9/17 8/9/2017 $ $ /1/17-9/13/17 **9/13/17 $ $ /1/17-10/4/17 10/4/2017 $ $ /1/17-11/8/17 11/08/17 $ $ /1/17-1/10/18 01/10/18 $ $ /1/17-1/10/18 01/10/18 $ $ **Upon successful completion of the online coursework and associated skills session, student is eligible to contact the Texas Commission on Fire Protection Certification department to request an Individual Application for testing packet in order to take the written certification exam. PLEASE CONTACT TCFP AT for more information. If wishing to take the written certification exam at Kilgore College Fire Academy, you must rforsythe@kilgore.edu an request for a Walk-In Letter identifying your name, discipline testing, and date of exam. MAIL, FAX, or registration to: KILGORE COLLEGE FIRE ACADEMY 1100 Broadway Kilgore, Tx (903) or (903) Office (903) KCFA@kilgore.edu rforsythe@kilgore.edu or nferguson@kilgore.edu

6 INSPECTOR required Textbook (1): Publisher: Fire Protection Publications ISBN: Edition: 7th Edition Year: 2009 Pages: 892 IFSTA Item Number: Textbook subject to change. Verify with office current textbook is correct before purchasing.

7 HOW TO CREATE A FIDO ACCOUNT Kilgore College Fire Academy must submit training rosters to the Texas Commission on Fire Protection by entering students TCFP PIN#. The TCFP PIN# is provided upon setting up a FIDO account through the Texas Commission on Fire protection. Listed below on the instructions on how to create your FIDO Account: Go to: Click on Create PIN/Account and this will take you to a screen asking you to select one of the following: US citizen/resident o I have a valid SSN o I do not have a valid SSN Canadian citizen/resident **use SIN# (insurance) Foreign (Not US/Canadian) **cannot self-create a PIN in the TCFP system Next screen will have you enter your social security (insurance) number and a valid address. Be sure and use a current valid address that you have access to as your TCFP PIN# will be sent to said address entered at this point! Click Submit. Next screen will have you enter your personal information. All information marked with a red * are required fields. An with your TCFP PIN # will be sent to your address entered above. Please check your for this information and provide on the above registration form.