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“First Alarm” Series
Meet the Director
History
“First Alarm” Series
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Richard M. Flynn Training Facility, Concord
Raymond S. Burton Training Facility, Bethlehem
Training Props
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Richard M. Flynn Training Facility, Concord
Raymond S. Burton Training Facility, Bethlehem
Training Props
Apparatus
Initiatives
Automated External Defibrillator (AED) Registry
Training Reimbursement: New Recruitment, Retention, and Development Initiative Announced
Education Training Agency
On My Time Firefighter I&II Training Program
Automated External Defibrillator (AED) Registry
Training Reimbursement: New Recruitment, Retention, and Development Initiative Announced
Education Training Agency
On My Time Firefighter I&II Training Program
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Fire Standards & Training Commission
FSTC Curriculum Projects
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Fire Standards & Training Commission
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Psychomotor Eligibility to Test Application
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“On My Time” Firefighter I and II Training Program
Psychomotor Eligibility to Test Application
Certification Reciprocity
Learning Accommodation Request
Online Classroom
Skills University
Support
“On My Time” Firefighter I and II Training Program
Public Resources
Automated External Defibrillator (AED) Registry
EMS Simulation Program
How to Become a First Responder
Statewide Employment Opportunities
Trauma System
Automated External Defibrillator (AED) Registry
EMS Simulation Program
How to Become a First Responder
Statewide Employment Opportunities
Trauma System
First Responder Resources
A Guide for New Fire Chiefs
EMS Accolades Report
Licensing for Emergency Medical Services
Patient Care Protocols
Preplanned EMS Standby Coverage Best Practices
Statewide Employment Opportunities
A Guide for New Fire Chiefs
EMS Accolades Report
Licensing for Emergency Medical Services
Patient Care Protocols
Preplanned EMS Standby Coverage Best Practices
Statewide Employment Opportunities
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Academy Resource Request
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EMS Request for Examination
Initial Course Request Form (CREF)
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Academy Resource Request
Curricula
EMS Request for Examination
Initial Course Request Form (CREF)
State Fire Instructor Application & Renewal
Instructor Examination Request
Instructor Mentoring Program
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EMS Instructor Portal
Student Job Performance Report
Careers
Initial Course Request Form (CREF)
Home
›
Initial Course Request Form (CREF)
Step
1
of
6
16%
Requesting Instructor
*
You must be a licensed EMS Instructor Coordinator or State or Staff fire instructor.
Instructor Email address
*
Type of Course being requested
*
Fire
EMS – Licensed Instructor Coordinator
EMS – Educational Training Agency
EMS – Division Sponsored
Name of Agency requesting the training:
*
Please select the type of EMS course you are requesting:
*
EMR Initial (EMR)
EMR Scope of Practice Moduels (RSOP)
EMT Initial (EMT)
EMT Scope of Practice Modules (ESOP)
EMS I/C Programs (INSTED)
AEMT Initial (AEMT)
AEMT Scope of Practice Modules (ASOP)
Paramedic Initial (P)
Paramedic Scope of Practice Modules (PSOP)
Continuing Education, Seminars and Training (CON)
PEETE (PEETE)
Challenge for Medical Professionals (CMP)
Please select the type of Fire/EMS course you are requesting:
*
Please select a course:
Airport Firefighter
ARFF live fire recertification
Basic Pumps Operations
Cancer Awareness
Courage to be Safe
Driver Operator – All Vehicle
Driver Operator – Aerial Apparatus
Driver Operator – Pump Apparatus
EMR – Division Sponsored
EMS New Instructor Orientation
EMS Continuing Education
EMS – PHTLS
EMS Simulation Program
Emergency Preparedness and ODP
Fire and Emergency Services Instructor I
Fire and Emergency Services Instructor II
Fire and Emergency Services Instructor III
Fire Inspector I
Fire Inspector II
Fire Officer I
Fire Officer II
Firefighter I
Firefighter I – Modules (specify below)
Firefighter II
Firefighter II – Modules (specify below)
Firefighter I & II
Firefighter III – Confined Space Technician
Firefighter III – Ice Rescue Technician
Firefighter III – Rope Rescue Technician
Firefighter III – Trench Rescue Technician
Hazardous Materials Awareness
Hazardous Materials Operations
Hazardous Materials Decontamination
Hazardous Materials Technician
IAFF Fireground Survival
ICS 100 Intro to ICS
ICS 200 Basic ICS
ICS 300 Intermediate ICS
ICS 400 Advanced ICS
Instructor development
Instructor Mentor TtT Program
National Fire Academy
ODP
Other
Rope Rescue Operations
Radiological Equipment Training (RET)
Seminar
Swiftwater Rescue Awareness
Swiftwater Rescue Level I
Swiftwater Rescue Level II
Swiftwater Rescue Boat Operations
Training for Rapid Intervention Teams
Train the Trainer
Wildland Firefighter I
Wildland Firefighter II
Please enter the name of the course:
*
Simulation Hours
Is this the first time course has been offered?
No
Yes
Curriculum Information
Is this program ProBoard certified?
*
Yes
No
NFPA Standard #
*
NFPA Edition
*
Please select the type of certification that shall be issued?
*
None
Certificate of Attendance
FST Commission Certification
Online Certificate
HSEM Certificate of Attendance
Minimum number of students
*
Maximum number of student
*
Number of student hours
*
Is this program broken down into modules?
*
Yes
No
List the modules below
*
Please click the plus symbol on the right hand side to add additional modules.
Module Name
Module Hours
Are there any prerequisties for this course?
*
Please only list REQUIRED prerequisites.
Yes
No
Please provide a short course description or link to a course description
*
Please list the required prerequisite training courses
*
Location information
Where is the course being held?
*
Field
Fire Academy
Bethlehem
Gorham office
Virtual (no location)
Facility Name
*
Please specify the physical address of the course
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Maximum number of student
*
Are you planning to teleconference this training:
*
Yes
No
Which locations are you planning to teleconference to?
*
Bethlehem
Gorham
45th Parallel EMS
Other
Other Teleconferencing Site
*
Teleconference site address
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Program start date
*
YYYY dash MM dash DD
Program end date
*
YYYY dash MM dash DD
Is this course being offered at multiple locations?
No
Yes
First Additional Location Name
First Additional Location Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Second Additional Location Name
Second Additional Location Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Course Schedule information
Course Schedule
*
Mon
Tues
Wed
Thurs
Fri
Sat
Sun
Weekday start time
*
:
Hours
Minutes
Weekday end time
*
:
Hours
Minutes
Weekend start time
*
:
Hours
Minutes
Weekend end time
*
:
Hours
Minutes
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Additional Firefighter I program information
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Hazmat Awareness Test Date
*
YYYY dash MM dash DD
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Hazmat Operations Test Date
*
YYYY dash MM dash DD
EMS Course Information
Course Medical Director
*
Would you like to include the Scope of Practice modules with this request?
*
Yes
No
Would you like this advertised on the Course Catalog?
*
Yes
No
Please provide all contact information to be displayed on the Course Catalog.
*
Please attach a copy of your course syllabus or course outline
*
Accepted file types: pdf, xls, xlsx, doc, docx, jpg, gif, Max. file size: 256 MB.
Course outline must contain at minimum the location, dates, times, and topics of each class.
You may upload a second file if needed.
Max. file size: 256 MB.
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Please attach a copy of your course syllabus
Drop files here or
Select files
Accepted file types: pdf, xls, xlsx, doc, docx, jpg, gif, Max. file size: 256 MB.
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Does the Division have a copy of your course and student guidelines on file?
Yes
No
Please attach a copy of your course and student guidelines
*
Accepted file types: pdf, xls, xlsx, doc, docx, jpg, gif, Max. file size: 256 MB.
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Does the Division have a copy of your clinical agrreement on file?
Yes
No
Please attach a copy of your Clinical / Field Internship Affiliation Form
*
The form can be found at:
https://www.nh.gov/safety/divisions/fstems/ems/documents/clinical.pdf
Accepted file types: pdf, xls, xlsx, doc, docx, jpg, gif, Max. file size: 256 MB.
Additional course information
Is the Division the Sponsoring Agency:
*
Yes
No
Sponsoring the course means we are one of the main organization coordinating the training program. We may partner with another agency but we are sponsoring the training. This might include responsibilities such as managing registration, handling payments, hiring instructors, providing resources, and overall ensuring the smooth execution of the training. It’s a significant commitment that often comes with various logistical and administrative duties to ensure the success of the program.
Partnership with an outside organization
Yes
No
Is the Division partnering/co-sponsoring this training with an outside organization. Example, the Division is partnering with the IAFF to bring in one of their programs to the State. The Division conducts the logistics and registration for the program.
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Course funding
Funded 35%: This is part of the Division’s budget programs
Non-Funded: Division does not bear the cost of this program
Contracted: The Division works with the Agency on a customized quote for the requested training. The Department agrees to pay for 100% of the course cost.
Funded-Tuition 35%
Non-Funded
Contracted
Grant Funded
Is the Division being contracted to offer this course??
*
Yes
No
If the Division is being contracted to offer this course a quote is required to be attached outlined the cost of the training program.
Please attached the quote for the contracted training program.
*
Max. file size: 256 MB.
Do you want this course list on the Course Catalog?
*
Yes
No
When would you like the application window to open?
*
YYYY dash MM dash DD
The sponsoring agency has the ability to submit applications prior the application window opening. Once the application window opens, applications will be processed on a first-come first-serve basis.
Additionally, the application window close day will be 10 days prior to the start of the class. In the event at the end of the application window there is still space available, applications will still be accepted. If an outside agency requires an earlier application window close date please include this information in the additional details on the last page.
Additional Information
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Upload any additional documents
Drop files here or
Select files
Accepted file types: doc, docx, pdf, xls, xlsx, Max. file size: 256 MB.
Upload any additional documents
Max. file size: 256 MB.
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