New York State-Department of State-Office of Fire Prevention and Control  -  Chief Authorization Letter
Fire Chief Authorization: (Please Enter All Information)
Fire Department Date Submitted
Chief's Name Date Signed
Chief's Authorization: I certify that this student meets all pre-requisites and is eligible and authorized to attend this course listed.
 Chief's Email: * send confirmation of registration
Course Information: (Please Enter All Information)
Course Code # Course Title
STUDENT INFORMATION: (Please Enter All Information)
Last Name First Name MI
Address City State
Home Phone Work Phone Zip Code
Student's Email: * send confirmation of registration

To the Office of Fire Prevention and Control:

This letter is to advise you that the student named below is authorized by myself to attend the course listed. I understand that during this course certain evolutions will be performed that simulate and/or create firefighting conditions. I do not hold the Office of Fire Prevention and Control responsible an/or liable for any malfunction or damage to any equipment supplied by my department. I further state that any equipment supplied is compliant to any standards required by OFPC.

The student has been certified to wear Self Contained Breathing Apparatus. I further state that the student has taken and passed his OSHA compliant Firefighter Physical and is authorized to wear an SCBA and participate in interior and exterior live firefighting operations.