Entry Level Training – Funding Request Application for Reimbursement of Entry Level Training Δ Step 1 of 3 33% Contact InformationEmergency Service Organization (ESO) Information(Required)Emergency Service Organization Name Emergency Service Organization ESO Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Person authorized to submit for reimbursement(Required) First Last Your Email Address(Required) Enter Email Confirm Email Mobile Phone(Required)Best Time To Call You if We Have QuestionsWhen is the best time for us to reach you via telephone?Mornings (8AM-11AM)Early Afternoon (11AM-2PM)Late Afternoon (2PM-4PM)Early Evening (4PM-6PM) Training Course You're Applying ForIndustry(Required) Fire Training – Entry Level Emergency Medical Services – Entry Level Available Entry Level Courses – Fire(Required) Entry Level curriculum course as prescibed by the PA State Fire Academy to complete the level of Fireground Support to include First Aid/CPR/AED Hazardous Materials Awareness Level Certification Test Traffic Incident Management Certification Test Support Firefighter Certification Test Available Entry Level Courses – EMS(Required) Emergency Medical Responder (EMR) + Certification Test Emergency Medical Technician/Basic (EMT-B) + Certification Test BLS Healthcare Provider CPR/AED Location of Course or Certification Test(Required) Lancaster County Public Safety Training Center (LCPSTC) Fire Company in conjunction with LCPSTC DOH Education Training Institute What Fire Company Held the Course or Certification Test?(Required)Student InformationName of Student(s)(Required)Please list names of student(s) whom funding reimbursement is being requested. Certificate/Certification of Completions need uploaded below for each student.First NameMiddle InitialLast NameEmailESO Name Add RemoveUpload Your Certificate/Certification of Completion(Required) Drop files here or Select files Accepted file types: acceptedfiletypes:jpg, png, pdf, doc, docx, maxfilesize:100mb, Max. file size: 100 MB. To ensure proper reimbursement, name the organization who initially covered the cost of the training.(Required)Address where reimbursement should be mailed(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Additional InformationLet us know if you have any additional information or questions below:I herby consent the following are true to the best of my ability.(Required) Emergency Service Organization (ESO) is a paid member of LCFA in good standing by 12/31/25 Student(s) are at least 16 years of age Student(s) are individual members in good standing of LCFA for a minimum of 2 years Student(s) are not a career/paid employee(s) an ESO Courses and/or certification were successfully completed Select AllTerms and Conditions(Required)I have read and agree that all the above conditions have been met to apply for funding. Any funding may be provided must be repaid if the information provided is proven false. I agree to the terms and conditions.
