Academy Resource Request

"*" indicates required fields

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Personal Demographics

Name*

First Middle Last

Do you work for the Department of Safety*

Your Division/Bureau*

Address*

Street Address City State ZIP Code

Your best contact phone number*

Your best contact Email*

Please select the resources that you would like to request*

Classroom/Facility/Dorm Room

Audio/Visual Equipment

Vehicle Request

Fire/EMS Course Prop Reservation

Vehicle Request

Program Name

Reason for travel*

Destination city/town*

Start Date*

MM slash DD slash YYYY

End Date*

MM slash DD slash YYYY

Start Time*

Hours

Minutes

AM/PM

End Time*

Hours

Minutes

AM/PM

Vehicle Information

Please select from the following:*

Utility 3 - GMC 2500

Utility 5 - Freightliner

S602 - Impala

S607 Transit

S608 - Silverado

S619 - Dodge Caravan

S620 - Dodge Caravan

Black Landscape Trailer

Red Landscape Trailer

Orange Flatbed (5th wheel)

Red Flatbed (5th wheel)

Facility Reservation

Start date that classroom or dormroom is needed*

MM slash DD slash YYYY

End date that classroom or dormroom is needed*

MM slash DD slash YYYY

Start time of event*

Hours

Minutes

AM/PM

End time of event*

Hours

Minutes

AM/PM

Are you requesting a CLASSROOM for an activity or a DORM room to stay in?*

Classroom or auditorium

Dormitory room

NO REQUESTS WILL BE APPROVED MORE THAN 60 DAYS PRIOR TO THE DATE OF THE ACTIVITY.

Requesting Organization*

Number of attendees*

Address of requesting organization*

Street Address City State ZIP Code

Contact person*

First Last

Position or title of contact person*

Activity description (how does this relate to the emergency medical or fire service, MUST be completed for consideration*

Facility reservation continued

Are you charging for this activity?

YES

Are you requesting to use a caterer at our facility?

YES

Once confirmed, please arrive early to the Fire Academy to ensure the classroom is setup in the style you prefer. At this time groups are responsible for configuring the classroom and rearranging it at the completion of the utilization.

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Classroom set up:

POD style

Box style

U Shaped style

Classroom style

Select from the following

Auditorium

Single classroom

Double classroom

Please select the classrooms you would like as part of the double classroom option:

Classroom 1

Classroom 2

Classroom 4

Classroom 5

Classroom 6

Classroom 7

ARFF Classroom

North Country Training Facility Classroom

Do you need a conference call line?

Yes

This is for the Division of FST&EMS only, if you need the conference phone please include an AV request

Will your event be held after business hours (before 8:00am or after 4:30pm or weekends)?

Select one

YES

Please indicate the number of hours that your event will last in order to have facility staff on site and available (after normal business hours)

Total

Dormitory Room Reservation

Emergency Contact Person*

First Last

Emergency contact person phone*

How many nights will you be staying?

Dormitory payment form

Copy and paste the URL link below into your web browser in order to download the dormitory payment form. Complete the form then attach it using the upload link below in order to send it with your online submission.

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Upload your payment page form here to send with your submission

Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 256 MB.

Total

Audio Visual Request

Start Date

MM slash DD slash YYYY

End Date

MM slash DD slash YYYY

Time

Hours

Minutes

AM/PM

I will need the following AV equipment:

Computer and Projector in Classroom

Conference Phone

Portable Projector Screen

Portable AV Kit for a Field Program

Video Camera

Digital Still Camera

It is recommended that you bring your presentation with you on a flash drive and use the provided podium computer. Your laptop or other device may not work properly with the academy system and you may not be able to display your presentation directly from your laptop depending on its age or style/type.

The conference phone will be delivered to the classroom and it is your responsibility to set the phone up and connect it to the network. The ED TECH group is not versed or responsible for conference phone connections.

You will be required to pick up the portable AV kit from the ED TECH office at the Fire Academy. A team member will open and review the kit contents with you to ensure that it is working properly. You will be responsible for the kit condition and its contents while it is in your possession. If something becomes broken you will be asked to place an out of service tag on the kit.

All persons who are requesting the use of our video cameras MUST be versed in their use. You will be responsible for filming your presentation or project as ED TECH personal are not included with the camera request to film. You will be responsible for the camera kit and its contents and condition while it is in your possession.

I will need access to the Academy's wireless network.

YES

In order to access the wireless network you will need a one day access code pass and enter that information into the login screen when you open your internet browser on the day of your event. This pass can be obtained from the front reception desk when you arrive.

Fire Prop Reservation

Name of Requesting Agency or Department Affilication*

Name of training site

Training site address where class will be held

Street Address City State ZIP Code

Delivery Contact Information

Contact person for prop delivery

First Last

AFTER HOURS contact phone number

Date of first training session

MM slash DD slash YYYY

Start time

Hours

Minutes

AM/PM

End time

Hours

Minutes

AM/PM

Is there a 2nd training date and time?

YES

Date of second training session

MM slash DD slash YYYY

Start time

Hours

Minutes

AM/PM

End time

Hours

Minutes

AM/PM

Is there a 3rd training date and time?

YES

Date of third training session

MM slash DD slash YYYY

Start time

Hours

Minutes

AM/PM

End time

Hours

Minutes

AM/PM

Props and Equipment

Please select from the following:

ADULT CPR Manikins (4 pack)

INFANT CPR Manikins (4 pack)

Air Trailer 1

Air Trailer 2

American Red Cross AED Trainers

Confined Space Props

Defibtech AED Trainers

Engine 1

Engine 2

Extinguisher Prop

HAZMAT Awaerness Operations Trailer

HAZMAT Tech Trailer

HAZMAT Decon Trailer

IAFF Fireground Safety Props (CREF classes only)

Ladder 1

Laerdal AED Trainers

Multi force door prop

North Country Training Facility- A Building

North Country Training Facility- Drillyard

North Country Training Facility- White House

NHFA Drillyard - ARFF Drill Yard

NHFA Drillyard

NHFA Drillyard - A Building

NHFA Drillyard - Auto Extrication

NHFA Drillyard - B Building

NHFA Drillyard - Flashover

NHFA Drillyard - Lifting and Jacking

NHFA Drillyard - LP

NHFA Drillyard - Vent Prop

NHFA Drillyard - Firehouse

NHFA Drillyard - J Building

Phillips AED Trainers

Rescue 1

SCBA Trailer

Trench Rescue Props

Zoll AED Trainers

Additional Notes (please list numbers of manikins or AED trainers needed

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Personal Demographics

Vehicle Request

Vehicle Information

Facility Reservation

Facility reservation continued

Select from the following

Dormitory Room Reservation

Audio Visual Request

Fire Prop Reservation

Delivery Contact Information

Props and Equipment

Quick Links

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