FST Student Enrollment Form
Course name
*
Host Department
*
Instructor Name
*
First Name
Last Name
Start Date
-
Month
-
Day
Year
Date
End Date
-
Month
-
Day
Year
Date
Name
*
First Name
Middle Name
Last Name
Suffix
Social Security Number
*
At this time, your social security number is the only way to track your fire service-sponsored training, without this information we cannot issue you a course certificate.
Gender
Male
Female
Non-Binary/Non-Conforming
Prefer not to respond
Birthday
*
-
Month
-
Day
Year
Date
Mailing address
*
Street Address
Street Address Line 2
City
State
Zip Code
County
*
Please Select
Ada
Adams
Bannock
Bear Lake
Benewah
Bingham
Blaine
Boise
Bonner
Bonneville
Boundary
Butte
Camas
Canyon
Caribou
Cassia
Clark
Clearwater
Custer
Elmore
Franklin
Gem
Gooding
Idaho
Jefferson
Jerome
Kootenai
Latah
Lemhi
Lewis
Lincoln
Madison
Minidoka
Nez Perce
Oneida
Out of State
Owyhee
Payette
Power
Shoshone
Teton
Twin Falls
Valley
Washington
Work phone
*
Please enter a valid phone number.
Cell phone
*
Please enter a valid phone number.
Email
example@example.com
Your Department/Organization Name
*
Department Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Your signature
Today's date
-
Month
-
Day
Year
Date
Submit
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