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Collects course information, prerequisite acknowledgement, course dates, and location details, and requires complete student identity, contact, address, and eligibility data including student ID or last four digits of SSN and date of birth. Includes current fire department/organization details, rank/position, and signature/date acknowledging waiver terms on the back. 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FAILING TO PROVIDE THIS INFORMATION WILL VOID THE REGISTRATION) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| Student ID or Last 4-digits of SSN\u003Cbr>􀀀 􀀀 􀀀 􀀀 􀀀 - 􀀀 􀀀 􀀀 􀀀 |  |  |  | FIRST MI LAST |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date of Birth |  |\n| Home Address |  |  |  |  |  |  | City |  |  |  | State |  |  |  | Zip |  |  | County |  | Code \\# |\n| Home \\# |  |  |  |  |  | Fax \\# (optional) |  |  |  |  |  |  |  | Cell / Pager \\# (optional) |  |  |  |  |  |  |\n| Gender 􀀀 Male 􀀀 Female |  |  |  |  | E-mail ADDRESS |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| \u003Cbr>Current Fire Department / Organization Information |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| Rank/Title/Position | Current Position: 􀀀 Career 􀀀 Part Paid FF 􀀀 Volunteer FF 􀀀 Other (specify) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| Fire Department/Organization Name |  |  |  |  |  |  |  | Address |  |  |  |  |  |  |  |  |  |  |  |  |\n| City |  |  |  |  |  | State |  |  | Zip |  |  | County |  |  |  | Code \\# | FDID/Agency \\# (if known) |  |  |  |\n| I acknowledge that I have read, understand and accept the terms of the waiver on the back of this form.\u003Cbr>Signature: Date: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n\nCounty codes and Waiver information is located on the back of this form  \nPREVIOUS EDITIONS OF THIS FORM ARE OBSOLETE  \nAn equal opportunity employer and service provider  \nCOUNTY CODES  \n\n| 1 Adams | 12 Clark | 23 Fairfield | 34 Harrison | 45 Licking | 56 Monroe | 67 Portage | 78 Trumbull |\n| --- | --- | --- | --- | --- | --- | --- | --- |\n| 2 Allen | 13 Clermont | 24 Fayette | 35 Henry | 46 Logan | 57 Montgomery | 68 Preble | 79 Tuscarawas |\n| 3 Ashland | 14 Clinton | 25 Franklin | 36 Highland | 47 Lorain | 58 Morgan | 69 Putnam | 80 Union |\n| 4 Ashtabula | 15 Columbiana | 26 Fulton | 37 Hocking | 48 Lucas | 59 Morrow | 70 Richland | 81 Van Wert |\n| 5 Athens | 16 Coshocton | 27 Gallia | 38 Holmes | 49 Madison | 60 Muskingum | 71 Ross | 82 Vinton |\n| 6 Auglaize | 17 Crawford | 28 Geauga | 39 Huron | 50 Mahoning | 61 Noble | 72 Sandusky | 83 Warren |\n| 7 Belmont | 18 Cuyahoga | 29 Greene | 40 Jackson | 51 Marion | 62 Ottawa | 73 Scioto | 84 Washington |\n| 8 Brown | 19 Darke | 30 Guernsey | 41 Jefferson | 52 Medina | 63 Paulding | 74 Seneca | 85 Wayne |\n| 9 Butler | 20 Defiance | 31 Hamilton | 42 Knox | 53 Meigs | 64 Perry | 75 Shelby | 86 Williams |\n| 10 Carroll | 21 Delaware | 32 Hancock | 43 Lake | 54 Mercer | 65 Pickaway | 76 Stark | 87 Wood |\n| 11 Champaign | 22 Erie | 33 Hardin | 44 Lawrence | 55 Miami | 66 Pike | 77 Summit | 88 Wyandot |\n\nThe OHIO FIRE ACADEMY, Division of State Fire Marshal, Ohio Department of Commerce (herein “ACADEMY”), in making available its or other selected facilities, training grounds, equipment, and its staff, and in its provision of an opportunity to learn on the part of its students and other invitees, makes no representation of a","cbCaijBnV7kb5UM3","https://ap.wps.com/l/cbCaijBnV7kb5UM3","pdf",56511555,180,"English","# Student Registration Overview\n## Course Information\n## Student Information\n## Fire Department / Organization Information\n## Waiver Acknowledgment\n## County Codes","[{\"question\":\"What information is required for student registration on this form?\",\"answer\":\"The form requires course information and complete student details, including student ID or last four digits of SSN, name, date of birth, home address, gender, email, and related contact fields unless specifically noted as optional.\"},{\"question\":\"How does the form address prerequisite requirements for the class?\",\"answer\":\"It includes a prompt asking whether the student has met the prerequisite for the class, with Yes/No selections.\"},{\"question\":\"What does the signature and date section confirm?\",\"answer\":\"The signature/date section acknowledges that the student has read, understands, and accepts the waiver terms located on the back of the form.\"}]","IG Ohio HazMat WMD Training Series Manual Module 1 - Direct Delivery Student Registration | PDF",1790734133,454]