Colorado Firecamp course application

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This form may be used in place of the NWCG nomination form (PMS 921-2). S-130/190 does not require agency sponsorship or supervisor signature. Rosters will be filled on a first-come, first-served basis.

Colorado Firecamp
9008 County Road 240
Salida, CO 81201

E-mail us with any questions: learn@coloradofirecamp.com or call (719) 539-9329 or fax (719) 530-0316
www.coloradofirecamp.com

Student's Last Name *

Student's First Name *

Student's Job Title

Student's Billing Address *

Student's City *

Student's State *

Student's Zip Code *

Student's Phone number *

Student's E-mail Address *

Student's Gender (for rooming purposes) *

Female

Male

Prefer not to say

Other:

Fire Department, Agency or Company Name

Supervisor's Name

Supervisor's Telephone Number

Supervisor's Email for Invoice

Does student meet all course prerequisites, if any? *

S-130/190 Basic Firefighter has no prerequisites.

Yes

Required

Select the class *

Select your desired class from the list below.

Payment *

Payment is due by the first day of class. You may pay earlier, if you prefer. If your agency or fire department will be paying, select "please invoice my agency." Military veterans also have the option to submit paperwork for using the Post-9/11 GI Bill® or AmeriCorps Education Award. Unfortunately, at this time we are only able to accept AmeriCorps Education Awards from military veterans.

Does the student have Personal Protection Equipment (Nomex clothing, Line Pack w/shelter, boots, hard hat, leather gloves, eye protection) for live fire, or course related, field exercises? Some loaner equipment is available.

CHAINSAW COURSES ONLY (S-212): Does the student have Personal Protection Equipment for chainsaw related courses (Long sleeve shirt, long pants, leather boots/gloves, chaps, hardhat, eye/ear protection)? Will the student be bringing a chainsaw and related equipment? Some loaner equipment is available.

Is student arriving by Bustang bus the day before the class starts?

Does student need picked up at the Salida bus stop the evening before the class starts? Note: if you are arriving by bus the day before, you need to select yes for an extra night lodging.

Yes, I need a ride from the bus stop in Salida.

No, I'm driving my own vehicle or will make other travel arrangements.

Does the student have any dietary restrictions/food allergies? Please describe.

Does the student need an extra night of lodging prior to the start of course? Each extra night of lodging costs $35.

Yes

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