Mentor Agreement Form

New Instructor Candidate Demographics
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Instructor Candidate Phone*
Instructor Candidate Email*
Mentor Demographics
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Mentor Email*
Mentor Phone*
By clicking this box, the new instructor candidate and the mentor agree to work together to meet the objectives of the mentoring program and follow all rules and regulations pertaining to it.*
- We Agree
- We DO NOT Agree

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We are committed to training, educating, and certifying emergency and community responders to protect the citizens and visitors of New Hampshire.

98 Smokey Bear Blvd
Concord, New Hampshire 03301

fstems@dos.nh.gov

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Division of Fire Standards and Training & Emergency Medical Services. All Rights Reserved.

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