BURKE COUNTY FIRE AND RESCUE COLLEGE

Transcription

1 BURKE COUNTY FIRE AND RESCUE COLLEGE

2 DEDICATION Randy L. McKinney Randy started as a volunteer firefighter in 1976 with the Oak Hill Fire Department and served for over 30 years. He is currently a volunteer firefighter in the West End Fire Department. He was one of the first certified EMTs in Burke County and obtained the certification of Paramedic in Randy was employed by Burke County EMS, where he was promoted to the Director of EMS and Assistant Emergency Services Director. He retired in Currently, he owns and operates a consulting training business for emergency services. Randy initiated and was involved in a number of training programs designed to enhance the level of pre-hospital care in Burke County. Randy is a fire service instructor, EMS instructor, adjunct instructor for the National Fire Academy, and a FEMA instructor. He is also nationally certified as a Type Ill Incident Commander, Planning Chief, and Operations Chief. In addition to his formal education and training, he has served in numerous leadership roles. Randy is involved in various aspects of training through community colleges across the state, both as a student and as an instructor. We would like to thank Randy for his dedication and leadership throughout the years.

3 DUAL (CONCURRENT) ENROLLMENT This form is required for current high school students years of age. It must be completed and returned with the Registration Form. Participants under 18 years of age will be allowed to enroll in classroom activities only. is currently enrolled, taking the equivalent of one-half of a full-time schedule, and making progress toward graduation. Permission is granted for he/she to enroll in ~atthe2014burkecountyfire & Rescue College, to be held at Western Piedmont Community College's Foothills Higher Education Center in Morganton, North Carolina. The student must be 16 years of age to participate. Principal/Counselor Signature Date HighSchool Student Signature Parent/Legal Guardian Signature Approval of Director of Records & Registration (or designee) 21

4 The 2014 Burke County Fire and Rescue College Is made possible by the partnership between Western Piedmont Community College's Emergency Services Training Center and the Burke County Firefighters Association. Burke County Firefighters Association P.O. Box 219 Morganton, NC 28680

5 In Memory Joseph W. Autrey July 2, 1974 April 26,

6 INVITED VENDORS Anchor-Richey EVS Atlantic Emergency Solutions Brent's Customs Blue Ridge Rescue Suppliers Carolina Fire Rescue EMS Journal Cornerstone Specialty Equipment Fire Engine Collectables Fisher's Sportswear Harrison's Public Safety L&A Emergency Equipment Local Government Federal Credit Union Medical Supply Solutions MES Mountain Tek My Angel Tool Newton's Fire & Safety Equipment N.C. Forest Service N.C. Society of Fire Rescue Instructors Radio Communications Co. Rhinehart Fire Services Safe Industries Stevens Fire Equipment Tar Heel Emergency Sales VFIS of N.C. Wendy B's 911 Think Signs 2

7 TABLE OF CONTENTS General Information/Directions/Motel Accommodations Agenda Courses: Building Construction- Sat/Sun Emergency Medical Care Fire Alarms & Communications Fire Behavior Fire Control Fire Department Orientation & Safety Fire Hose Streams and Appliances Forcible Entry HAZ MAT Levell Responder Ladders Overhaul Portable Extinguishers Rescue Salvage Ventilation Water Supplies EVD Introduction to Pumps TR General: Helicopter Transport TR General Ropes TR General: Rescue Operations Emergency Incident Rehabilitation Small Aircraft Crash (ARFF) Understanding the NC Rating Response System NIMS Incident Command System ICS-300 EMT Refresher Chief101 Wildland Fire Red Card Training Forms Vendors Verification of Training for Live Burn Exercises Registration Form and Instructions Dual (Current) Enrollment PAGE

8 Burke County Fire & Rescue College: Foothills Higher Education Center 2128 South Sterling Street Morganton, NC All Burke County Fire & Rescue College classes will be held at this location. Practical exercises and other demonstrations will be held at the new Emergency Services Training Center and will be determined during class times. DIRECTIONS From Interstate 40-Take exit 105. Turn right onto South Sterling Street. Travel through one stoplight and the Foothills Higher Education Center will be on your left. FIRE COLLEGE INFORMATION COST: $15.00 per person-all Emergency Personnel plus $70.00 per person-(1-24 hour class) for Non-Emergency Personnel or Out-of-State Participants Substitutions will be accepted for students who are unable to attend. Late registrations will be accepted if class size permits. Students should indicate a 1st, 2nd, and 3rd choice of classes. Notification will be made to students not registered for their 1st choice. Minimum Age Requirement: Participants must be a minim urn of 16 years of age to enroll in the Burke County Fire and Rescue College. Any participants ages 16 and 17 must have written permission from his/her High School principal. The written permission must be submitted with the registration form. A dual enrollment form is included on page 21. Participants under 18 years of age may only enroll in classroom activities. Emergency Contact Information: In the event that a student needs to be reached for an emergency while attending the College, calls should be directed to For other questions, contact Mike Willis at MOTEL ACCOMMODATIONS Make your reservations early! The fall season brings many visitors to the foothills of the Blue Ridge Mountains. Be sure to mention that you are attending the Burke County Fire and Rescue College. Comfort Inns & Suites Quality Inn Days Inn & Suites Hwy 64 at 1-40, Exit 103 Hwy 18 S at 1-40, Exit 1 OS Hwy 18 S at 1-40, Exit Sleep Inn Hwy 18 S at 1-40, Exit Hampton Inn Hwy 18 S at 1-40, Exit 1 OS Economy Inn Bethel Road at 1-40, Exit

9 AGENDA Foothills Higher Education Center Thursday, October 16 8a.m. HAZ MAT, Fire Control and Wildland Red Card begins. Friday, October 17 8a.m. 1 p.m. 5:30p.m. Vendor Set-Up Saturday, October 18 Classes begin based on course description Registration/ check-in FHEC main lobby 7:30a.m. Ba.m. Vendors Open Registration and check-in main lobby Refreshments provided 8 a.m. 12 p.m. 1 p.m. Classes begin based on course description Lunch provided Classes begin based on course description Sunday, October 19 8 a.m. Ba.m. 11:30 a.m. 12:30 p.m. Vendors Open Classes begin based on course description Lunch on your own Classes begin based on course description Refreshments and lunch on Saturday provided by Burke County Firefighters Association 5

10 FIREFIGHTER CERTIFICATION COURSES BUILDING CONSTRUCTION (FF II Certification) 15 Hours This course will describe the basic structural characteristics of the different types of building construction. The firefighter will be able to identify the general fire behavior expected with each type of building construction, including the spread of fire and the safety of the building, occupants, and firefighters. Indicators of building collapses will also be covered. Class Schedule: Saturday 8 a.m. -5 p.m. Instructor: Brian Carswell Sunday 8 a.m.- 4 p.m. Hickory Fire Department EMERGENCY MEDICAL CARE (FF I Certification) 15 Hours This course will provide the student with basic first aid skills including but not limited to: hemorrhage control, burns, poisons, basic airway management and AHA CPR certification for Healthcare Providers. Class Schedule: Saturday Sunday 8 a.m.-5 p.m. 8 a.m.-4 p.m. Instructor: STAFF FIRE ALARMS & COMMUNICATIONS (FF I & II Certification) 15 Hours This course will prepare students to efficiently understand and effectively manage both telephone calls for assistance and the use of 2 way communication systems employed by the fire service. Various types of alarm systems will be demonstrated to include the types of detectors utilized within those systems. Class Schedule: Saturday Sunday 8 a.m.-5 p.m. 8 a.m.-4 p.m. Instructor: Joey Belanger Morganton Public Safety 6

11 FIRE BEHAVIOR (FF I & II Certification) 12 Hours Fire behavior forms the basis of many operations on the fire scene. A basic understanding of the chemical and physical nature of fire is required for safe and effective fire control. Participants will become familiar with terminology; the fire triangle and tetrahedron; the stages of fire and its conditions, signs, and indicators; and the transfer of heat. Class Schedule: Friday 6 p.m.-1 0 p.m. Instructor: Saturday 8 a.m.-5 p.m. G. Winfield Abee Western Region Fire/ Rescue Coordinator FIRE CONTROL (FF I & II Certification) 33 Hours *Full PPE including SCBA Required* *Course begins at 8 a.m. on Thursday, October 16* This course will cover both theory and practical application of methods used in controlling vehicle fires, interior/exterior structure fires, ground cover fires and Class B fires. This is physically demanding course and students should prepare accordingly. Class Schedule: Thursday 8 a.m.-5 p.m. Friday 8 a.m.-6 p.m. Instructor: ESTC Staff Saturday 8 a.m.-5 p.m. Sunday 8 a.m.-5 p.m. NFPA 1403 Form required. No one under 18 years of age permitted to take this class. FIRE DEPARTMENT ORIENTATION & SAFETY (FF I & II Certification) *Full PPE required* 21 Hours Students will be exposed to the organizational structure and position roles of the fire and rescue service. Services provided and laws and regulations governing department functions will be covered. Various benefits and guidelines pertaining to departments and its members will be discussed. Students will become aware of the alarming rate at which fire and rescue personnel are injured or killed while performing duties. Case studies documenting incidents will be utilized to emphasize that safety is a number one priority in emergency services. Class Schedule: Friday 6 p.m.-1 0 p.m. Instructor: T. J. Patton Saturday 8 a.m.-5:30p.m. Mooresville Fire Dept. Sunday 8 a.m.-5:30p.m. 7

12 FIRE HOSE STREAMS AND APPLIANCES (FF I & II Certification) *Full PPE is required* 21 Hours This course will cover the use, care and maintenance of various types and styles of fire service hose, appliances and nozzles as outlined in NFPA Students will demonstrate proper hose lays for supply and attack operations and participate in proper nozzle selection based on different fire scenarios. Proper fire stream production will also be demonstrated as well as various types of hose loads and finishes. Practical exercises on Sunday will be held off campus. Class Schedule: Friday 6 p.m. -10 p.m. Instructors: Nick Reed Jr. Saturday 8 a.m.-5:30p.m. Hickory Fire Department Sunday 8 a.m. - 5:30 p.m. Tommy Oxentine Hickory Fire Department FORCIBLE ENTRY (FF I Certification) *Full PPE Required* 14 Hours Students participating in this course will be able to identify the different construction types of doors and windows as well as various locks and lock assemblies. Students will learn the proper techniques to force entry though these doors, windows, and locks using various tools carried on typical fire apparatus. Care and maintenance of forcible entry tools will also be covered. Practical exercise on Sunday will be held off campus. Class Schedule: Saturday 9 a.m.-5 p.m. Instructor: Jon Lowdermilk Sunday 8 a.m.-4 p.m. West End Fire Department 8

13 HAZ MAT LEVEL I RESPONDER 38 Hours *Course begins at 8 a.m. on Thursday, October 16* This course meets requirements for OSHA and NFPA edition. It is designed to develop, through competence for those who will respond to a hazardous material incident. It will also help to develop competencies to respond in a safe manner, help reduce the number of accidents and injuries, and help prevent exposure to hazardous material incidents. Students will use the DOT guidebook in a practical exercise. This will be a fast-paced course and will require outside reading. The course will identify basic options, requirements, and limitations of the methods used to control, contain or confine a hazardous material incident. Practical exercise will be included. Class Schedule: Thursday Friday Saturday Sunday 8 a.m.- 8 p.m. 8 a.m.- 8 p.m. 8 a.m.- 5 p.m. 8 a.m.- 5 p.m. Instructor: Mike Tinkham Training Solutions, LLC LADDERS (FF I Certification} *Full PPE Required* 14 Hours Ground ladders are an essential part of fire ground operations. This course will provide students with correct ladder identification, terminology, applications, carries, raises, care and maintenance. Working individually and as a group, students will perform various carries, raises and lowers. Students will also perform various hose applications and victim/firefighter rescue techniques utilizing ground ladders. Class Schedule: Saturday 9 a.m.- 5 p.m. Instructor: Sunday 8 a.m.- 4 p.m. Robin Triplett Morganton Public Safety OVERHAUL (FF I & II Certification} *Full PPE Required* 7 Hours Students will become familiar with ways of establishing safe conditions for overhaul practices, identifying the indicators of hidden fires, exposing hidden fires, and identifying the procedures for extinguishing small burning objects and large furnishings. Securing a fire scene and collecting and preserving evidence will be included. Practical exercises will be held off campus. Class Schedule: Sunday 8 a.m.- 4 p.m. Instructor: Ronnie Rector Morganton Public Safety 9

14 PORTABLE EXTINGUISHERS (FF I Certification) *Full PPE Required* 7 Hours Proper use of extinguishers can enable personnel to put out a small fire before it becomes life-threatening. Students will learn to identify the classes of fire and how to select the proper extinguishers to use for each fire class. Inspection, maintenance, and hydrostatic testing procedures will be explained. Practical exercises will be held off campus. Class Schedule: Sunday 8 a.m.-4 p.m. Instructor: G. Winfield Abee Western Region Fire/ Rescue Coordinator RESCUE (FF I & II Certification) *Full PPE Required* 24 Hours *Course begins at 1 pm on Friday, October 17 Because of the dynamics of today's fire service, firefighters respond to all types of emergencies. A firefighter's first priority is life safety. This course is designed to teach firefighters methods of victim removal under various emergency conditions. Students will utilize various tools and equipment for gaining access to victims, and perform proper carries and drags for different injuries and situations. Students will also learn to assist with special rescues such as MVA's, trench, elevator, and collapse rescue. Class Schedule: Friday Saturday Sunday 1 p.m.-1 0 p.m. 8 a.m.-5 p.m. 8 a.m.-5 p.m. Instructor: Clay Greene Lake James Fire Dept. SALVAGE {FF I Certification) 7 Hours Firefighters will learn to minimize losses during and after fires by reducing fire, water, and smoke damage through the use of good salvage procedures. Course content will include various folds, rolls, deployment of salvage covers, and the construction and use of water chutes and catchalls. Practical exercises will be held on campus. Class Schedule: Saturday 9 a.m.-5 p.m. Instructor: Ronnie Rector Morganton Public Safety 10

15 11

16 Emergency Vehicle Driver (D/0 Certification} 20 Hours This course will present the knowledge, skills, and ability to satisfy the NFPA 1002 Fire apparatus Driver/Operator Professional Qualifications 2009 Edition. Students must pass the practical and written exam with a score of 70% or above to receive certification. Although not required, participants are encouraged to bring apparatus they will be driving at their respective agencies. Students must be at least 18 years of age and have a valid NCDL to participate. Class Schedule: Friday 6 p.m. -1 Op.m. Saturday 9 a.m.-5 p.m. Sunday 8 a.m.-4 p.m. Instructor: Claude Huffman, Retired Morganton Public Safety INTRODUCTION TO PUMPS (D/0 Certification) 17 Hours This class will introduce the student to the job or individual requirements for pump operators and will detail the safe operation of the vehicle. Subjects will include: pump anatomy, pump panel and engine gauges, relief valves, and basic pump set-up. Must be 18 or older to participate. Class Schedule: Friday Saturday Sunday 7 p.m.-10 p.m. 9 a.m.- 5 p.m. 8 a.m.- 4 p.m. Instructor: John Stroup Salem Fire Department 12

17 TECHNICAL RESCUER CERTIFICATION TR GENERAL: HELICOPTER TRANSPORT (TR General Certification) 7 Hours Helicopter evacuation requires a coordinated effort between ground and flight crews to ensure the safety of everyone involved. Safety is the overall goal of any aero-medical transport or rescue operation and can be achieved through teamwork and good communication. Methods for establishing landing zones, types of patients that may need an air medical ambulance, and safe practices around both air medical helicopters and the Blackhawk helicopters used by the NC National Guard will be covered. An area medical helicopter is scheduled to appear, weather and call volume permitting. Class Schedule: Sunday 8 a.m.-4 p.m. Instructor: Gary Ramsey TR GENERAL: ROPES (TR General Certification) 20 hours This course will present the Technical Rescuer safe and effective methods of rescue in elevated and below grade environments using ropes, knots and rope related equipment. Mechanical advantage, anchors, anchoring techniques and stress loads will be covered. Class Schedule: Friday Saturday Sunday 6 p.m. -10 p.m. 8 a.m. - 5 p.m. 8 a.m. - 5 p.m. Instructors: Staff TR GENERAL: RESCUE OPERATIONS (TR General Certification) 10 Hours This course will identify the needed support resources, given a specific type of rescue incident so that a resource cache is managed, scene lighting is provided for the tasks to be undertaken, environmental concerns are managed, personnel rehabilitation is facilitated and the support operation facilitates rescue operational objectives. Class Schedule: Friday Saturday 7 p.m.-1 0 p.m. 9 a.m.-4 p.m. Instructor: Gary Ramsey 13

18 SPECIALITY NON-CERTIFICATION EMERGENCY INCIDENT REHABILITATION 12 Hours Emergency Incident Rehabilitation is a result of mandate NFPA This course teaches the responder to effectively perform responder rehabilitation on an emergency scene, and at emergency training sites. This is a combination classroom and practical skills class. Participants will learn the reasons for the mandate, how to effectively start rehab program for their departments, and will learn techniques for proper administration of the program. Responder Rehab program is ideal for chief officers, safety officers, first responders, EMT's Paramedics and SMAT members. An outdoor exercise is planned as part of the class. Instructor: John Bruner, NREMT-P, SMAT Coordinator, Lieutenant, McDowell EMS Equipment: Appropriate clothing for outdoor exercise Class Schedule: Saturday 9 a.m.- 4 p.m. Sunday 8 a.m. - 3 p.m. SMALL AIRCRAFT CRASH RESCUE (ARFF) 14 Hours This class is made up of classroom and hands-on training on the fire ground. The first day will consist of lectures that will cover aircraft rescue and firefighting in a broad view along with a focus on general aviation aircraft and the hazards of dealing with emergencies ofthis type of aircraft. Day two will begin on the training ground where students will get an up close look at a small general aviation aircraft. Students will learn proper approach procedures, stabilization of the aircraft, securing the aircraft with a proper shutdown, and several techniques for removal of victims from the cabin. There will be a live burn scenario where students will apply what they have learned to control an aviation incident. This class will utilize Cleveland Community College's new ARFF Training Aircraft. Students must meet minimum age requirements (18 years of age or older). NFPA 1403 guidelines will be followed, including facial hair guidelines. Requires Chief signature on Chief's Verification Form. Equipment: Full turnout gear required, SCBA and extra bottle. SCBA bottles must have current hydro-test date. Class Schedule: Saturday 8 a.m.- 4 p.m. Sunday 9 a.m.- 5 p.m. Instructors: Cleveland Community College Staff NCDOI and ARFF s 14

19 UNDERSTANDING THE NC RATING RESPONSE SYSTEM 12 Hours This class will review all of the newest information and factors, which go into the make-up of the Insurance Public Protection Classification for cities and rural fire districts. It is intended for those persons interested in improving and /or maintaining the Fire Departments Public Protection Classification, which possibly could result in lowering insurance premiums for property owners. This class will cover the Communications, Fire Department, Water Information and Community Risk Reduction for a Graded area in the New Rating Requirements. Class Schedule: Saturday Sunday 9 a.m. - 4 p.m. 8 a.m. - 3 p.m. Instructors: Terry Young Davie Summey NIMS INCIDENT COMMAND SYSTEM- ICS Hours This course provides greater description and details of the Incident Command System (ICS) organization and operations, including application of essential principles and description of air operations. There are five modules: Organization and Staffing, Organizing for Incidents and Events, Resources Management, Air Operations and Incident, and Event Planning. This course includes a final exam. In order to receive credit for any NIMS classes students must have a TERMS account and register for the class online. This is in addition to the BCFRC registration. Prerequisite: ICS-1 00, ICS-200, ICS-700 Class Schedule: Friday Saturday Sunday 6 p.m.-10 p.m. 9 a.m. - 5 p.m. 8 a.m. - 4 p.m. Instructors: Randy McKinney, Retired Burke County Emergency Services 15

20 EMT REFRESHER 24Hours This EMT refresher course is open to EMT's of all levels currently credentialed in North Carolina and/or by National Registry of EMT's.lt offers up to 24 hours of curriculum that adheres to North Carolina and NREMT guidelines. This refresher course is divided into 2 & 3 hours blocks. Students may attend any combination of topics or all of the topics. For more information, contact mwillis@wpcc.edu. Instructors: STAFF EMT -REFRESHER SCHEDULE Friday 8-11 a.m. 11 a.m. -12 Noon 1-3 p.m. 3-5 p.m. Medical Emergencies (allergic reactions, drug overdose, water related emergencies) Airway (assessment & management) Trauma Part 1 (trauma assessment, head & spine injuries) Pediatrics Part 1 (respiratory & cardiac management) Saturday 8-11 a.m. 11 a.m. -12 Noon 1-3 p.m. 3-5 p.m. Trauma Part 2 (chest & abdominal injuries, shock management) Pediatrics Part 2 (assessment) Pediatrics Part 3 (trauma management) Breathing (assessment & management) Sunday 8-11 a.m. 11 a.m. -12 Noon 1-3 p.m. 3-5p.m. Cardiology Part 1 (cardiac compromise, cardiac arrest) Pediatrics Part 4 (shock assessment & management) Cardiology Part 2 (post resuscitation care) Pediatrics Part 5 (delivery & post-delivery care) 16

21 CHIEF Hours This class consists of several programs that together will satisfy the 9s inspection criteria as specified by the North Carolina Administrative code. The primary objective of the course is to inform current and future chief officers of: the various aspects and complexities surrounding the operations and organization of North Carolina fire departments. understanding the basis of the procedures that govern a rating and response inspection. the various aspects of the response rating system as adopted in North Carolina. recognizing various sources of information that will assist departments in preparing for an inspection. Emphasis will be placed on ratings and inspections, NFIRS reporting, prevention and grant programs, basic line-of-duty death information, financial considerations, and an overview of the various expectations of being a chief officer. Class Schedule: Saturday 9 a.m.- 4 p.m. Sunday 8 a.m.- 3 p.m. Instructor: Kevin Gordon, Charlotte FD Waco Community VFD Wildland Firefighter Red Card Training 36 Hours This course covers S-130, S-190 and L-180 NWCG Standards containing objectives of entry level Firefighter skills to identify hazards, safety, fireline construction and fire control measures. The course also covers wildland fire behavior and factors that affect fire development. Class Schedule: Thursday, Friday 8 a.m.-7 p.m. Saturday, Sunday 8 a.m.-5 p.m. Instructor: Chris Moss Burke County Ranger 17

22 COMMUNITY COLLEGE VERIFICATION OF TRAINING FOR LIVE BURN EXERCISES Tile firefighters listed below have received the minimum amount of training required by the 2012 edition ofnfpa As stated in NFPA 1403 Chapter 4 section 4.3.1, "Prior to being pennitted to participate in live fire training evolutions, the student shall have received training to meet the job perfom1ance requirements for Fire Fighter I in NFPA 1001, Standard for Fire Fighter Professional Qualifications, related to the following subjects:" (1) Safety (2) Fire Behavior (3) Portable Extinguishers (4) Personal Protective Equipment (5) Ladders (6) Fire Hose, Appliances & Streams (7) Overhaul (8) Water Supply (9) Ventilation (10) Forcible Entry (11) Building Construction An original Chiers Signature is required by each firefighter's name listed below. Student Name(s) Chiefs Signature Documentation of training will be made available to Western Piedmont Community College upon request. Fire Department Fire Chief's Name Date 18

23 IMPORTANT INFORMATION Please send all registrations in by Monday, October 6, Registration forms must be filled out completely and legibly (please print). Please write out your agency name in the Department affiliation section. Please write out your agency duties in the Primary duties section. Example: Firefighter, Telecommunicator, Police Officer, Etc. Circle either Paid or Volunteer. Circle either State Agency or Local Agency. Student and Chief signature must be on all registration forms. Each participant 16 to 18 years of age and who are in high school must have a WPCC Concurrent Enrollment form signed by his/her high school principal and sent in with the registration from. Participants 16 to 18 years of age may not participate in Fire control or Small Aircraft Crash Rescue courses. Particpants enrolling Fire Control or Small Aircraft Crash Rescue must include Verification of Training Form signed by the agency Chief with registration form. Students cannot be officially enrolled in any course until all documentation and payment is received. Substitutions will be accepted for students who are unable to attend. Late registrations will be accepted if class size permits. Indicate 1st, 2nd and 3rd choices. *****Western Piedmont Community College is a tobacco-free campus***** FEES Burke County Fire and Rescue College fee is $15.00 per person (non-refundable) for all participants. For Non-Emergency Personnel or Out-Of-State Participants, an additional registration fee of $70.00 per person for classes that are 1-24 hours in length and $ for classes that are hours in length is required. Mail ALL necessary and completed forms along with payment to: Western Piedmont Community College Attn: Business Office/Fire College 1001 Burkemont Avenue Morganton, NC Make checks payable to: Western Piedmont Community College Western Piedmont community college s policy regarding acceptance of checks: 1. All checks must include a physical street address. 2. Individual and company owned checks must include a driver license number. 3. All checks must include a phone number (work or home). 4. Counter checks, credit card checks, and computer-generated checks will not be accepted. For registration and payment questions, contact Christine Brown at or cbrown@wpcc.edu For questions regarding courses and their content, contact Michael Willis at or mwillis@wpcc.edu

24 WESTERN PIEDMONT COMMUNITY COLLEGE Mail to: Western Piedmont Community College Attn: Business Office/Fire College 1001 Burkemont Avenue Morganton, NC Name Social Security # Ethnic Origin (Check one): Hispanic (HIS) Non-Hispanic/Latino (NHS) If this option was selected please complete the following Race section below: Race (Please choose one): American/Alaskan Native (AN) African American (BL) Gender: Female Male Caucasian (WH) Hawaiian/Pacific Islander (HP) Asian (AS) Information collected within this box is voluntary and for record keeping purposes only and will not be used in a discriminatory manner. This information is required for federal and/or state reports, and for OSFM certifications. After registration, this information will be destroyed. Please list your 1 st, 2 nd, & 3 rd choice of classes. Please note that we will make all attempts to register you for the selected class choices; however, if the class/es are full or cancelled, we will automatically register you for the next listed choice. 1st 2nd 3rd Name: (Last) (First) (Middle) Mailing Address: City: State: Zip: County: Home Telephone: ( ) Work or Cell: ( ) Date of Birth: Highest Educational Level Completed: Date last attended school (not a college): Employment Status: Retired (R) Unemployed-Not Seeking Employment (UN) Unemployed-Seeking Employment (US) Employed 1-10 hours/week (E1) Employed hours/week (E2) Employed hours/week (E3) Employed 40+ hours/week (E4) Citizenship: US Citizen (U) Eligible Legalized Resident Alien (E) Naturalized Citizen (N) Non-Resident Alien (A) Undocumented Alien (D) Please note that to be eligible for fee exemption, the course/s you are registering for must be directly related to job performance or necessary to continue certification. If the information below is not populated in its entirety, there will not be a fee waiver and the student will be responsible for payment. The student s registration will be flagged to disallow further registrations until payment in full is made or the required fee exemption information is received by Continuing Education Records. WPCC reserves the right to ask for verification of fee exemption eligibility from the student and/or agency. Department Affiliation (example: Fire, Rescue, EMS): Clearly Print Department/Agency/Name (No Abbreviations) Primary Duties Within Department: Paid or Volunteer AND State Agency or Local/County Agency Certification Courses Student signature is required for this course as proof of registration and if the class is for certification, by affixing my signature, granting permission to release the appropriate course information to any appropriate certifying agency. Student Signature Date Chief Signature Date