Online Course Production Request

ET Project Intake Form

Project Sponser
Name*
First Last
Email*
Phone*
Bureau or Section*
If you are not the supervisor of this section, please provide their name
Project Details
Name of the Project*
Who is the intended audience that this project will be for?*
Please list out the overall goal of the project.*
Please list out the objectives of the program that will support the above goal.*
How many students will this training be intended to reach?
What is the proposed timeline to have this program in place and available to students?
What is the project deadline in which it must be finished by?*
MM slash DD slash YYYY
Is this project part of a series of other projects?*
- Yes
- No
Formats that this Training will be Delivered
Please indicate how this program will be delivered*
Does this project require an evaluation?*
- Yes
- No
Will this project require a certificate of completion?*
- Yes
- No
What project resources will be provided (i.e. PPT presentations, scripts, pictures, etc)
If these materials are copyrighted, can you supply the permissions to use them?
- Yes
- No

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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

©2020 New Hampshire Department of Safety
Division of Fire Standards and Training & Emergency Medical Services. All Rights Reserved.

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