2023 CAP Course Nomination Form

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These tuition-free Casualty Assistance Program courses are hosted as part of the 2023 TN-KY Wildland Fire Academy.

Please submit a form for each course you wish to nominate yourself for.

Email *

First Name *

Last Name *

Full name as it should appear on course certificate. *

Example: John J Doe

Secondary Email Address *

Enter a secondary email address you will be able to access from November-January and during periods of leave.

Phone Number (XXX-XXX-XXXX) *

Enter a telephone number (including area code) at which you can be contacted if there a questions regarding your nomination(s).

IQCS # *

Enter your IQCS Employee ID. If you do not have an IQCS # enter n/a.

Job Title *

What is your working job title?

Emergency Contact Information *

List name and phone number of emergency contact.

Supervisor's Full Name

Supervisor's Email *

Supervisor's Phone Number (XXX-XXX-XXXX) *

USFS Fire? *

If you are an employee of the USFS, indicate whether your position is a primary or secondary covered fire position (YES) or not a fire position (NO). If you are not a USFS employee, choose N/A.

YES

N/A

Sponsor *

Indicate the unit that certifies your qualifications (issues your qualification card). If you are an employee of any park in the Southeast Region, choose option 6. If you are an employee of any refuge in USFWS Region 4, choose option 7. Option 9 applies ONLY to employees of the SA Regional Office, not to all forests in the Southern Region.

Home Unit *

Enter your 5-6 character unit identifier (Examples: KY-KYS, FL-EVP, GA-CHF, GA-R4R, VA-VAS). Find your UNIT ID HERE: https://drive.google.com/file/d/1RWrX_wZ0JOa1dpHbAiB6i_wDvlPDaRrn/view?usp=sharing

Please select the course you wish to submit a nomination for. *

Please list any other courses at the Academy you are applying for. (Remember you must fill out another nomination form for those classes). If you aren't planning to take any other classes write N/A. *

This helps ensure you don't end up enrolled in two overlapping courses.

A copy of your responses will be emailed to the address you provided.

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