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18 years of age
Possess a Valid Drivers License
Be a member of the Allingtown Volunteer Fire Association and remain a member in good
standing (if not, complete AVFA Application for UNH Students)
Full-Time day student at the University of New Haven maintaining a minimum of 12
credits per semester and a GPA of 3.0
Participants must be able to obtain Connecticut FireFighter 1 and/or Connecticut EMT
within one year of being in the program.
Must be able to follow the Rules and Regulations of the Live-in Program
Must be able to follow the By-laws of the Allingtown Volunteer Fire Association
Must be able to follow the Rules and Regulations set forth by the City of West Haven
Fire Department
Must follow all Rules and Regulations while at an Emergency Scene, Firehouses and at
other firefighting functions.
Please note this application for the Livein Firefighter Program does not constitute application to the AVFA.
Application Period:
Applications need to be received by February 27, 2014.
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Section 1
Name:
Home Address:
City:
State:
Home Phone:
Zip Code:
Cell Phone:
E-mail Address:
Date of Birth:
Sex:
Major of Study:
Date of Graduation:
Date of AVFA Membership:
Section 2
Please Check the Approprite Box and Fill in Information as it Applies
1. Are you in the Fire Science Program?
2. Are you an Active Member of the Fire Science Club?
3. Are you an Active Member of the EMS Club?
4. Are you a member of another firefighting organization? (If yes, fill in section 3)
5. Have you applied for the AVFA Live-in Program before?
5a. Were you accepted? (If yes, answer 5b)
5b. How many semesters have you participated?
6. Are you currently FF1 certified or in a Fire Academy? (If yes, fill in Section 4)
7. Are you currently EMT certified or in EMT School? (If yes, fill in Section 5)
YES
NO
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Section 3
Name of Home Firefighting Organization:
City:
State:
Date Joined:
Position:
Chief or Supervisor:
Phone Number:
E-mail:
Section 4
If you do not have CT FF 1 is your certification national accredited? Proboard or IFSAC (Circle One or
Both)
Section 5
State(s) of EMT Certification:
Date Awarded CT:
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Relationship:
Name:
Phone Number:
Relationship:
Name:
Phone Number:
Relationship:
Additional Certifications:
1
2
3
4
5
6
7
8
9
10
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