Tcfp 015 Form – Fill Out and Use This PDF

Date Received	Texas Commission on	Date Approved
	Fire Protection
	Fire Service Standards & Certification Division
	P.O. Box 2286, Austin, Texas 78768-2286
	(512) 936-3826 Fax No. (512) 936-3808	Approved By
	Application for Individual Certification Renewal

**CERTIFICATES EXPIRED FOR ONE YEAR OR LONGER CANNOT BE RENEWED**

Verification of the status of your certification is available on your FIDO account or at the Commission’s website at: http://www.tcfp.texas.gov/home/FIDO_gateway.asp http://www.tcfp.texas.gov/certification/certification_verification.asp or contact the Commission at 512-936-3838.

Please address checks and money orders to TCFP.

**ALL RENEWAL FEES ARE NON-REFUNDABLE**

If you apply for renewal and do not meet the requirements OR send in the incorrect fee amount, a refund will not be issued.

**Do not submit your renewal documents without a signed copy of this application, continuing education documentation and payment of the required renewal fee and late fee if applicable.

Personal Information:

Phone:

Email:

Continuing Education:

20 hours of continuing education per year is required to renew all TCFP certificates, unless Hazmat Technician certification is also held. Ten additional hours of hazmat technician-level CE is required for individuals who are also certified as a Hazardous Materials Technician.

C.E. must have been completed within the 12 months prior to the expiration date of your certification. If you completed a commission approved academy in the 12 months prior to your expiration date, a copy of that certificate of completion would be acceptable documentation of C.E.

If you choose to document your continuing education on the commission’s C.E. documentation form (TCFP-010), a commission certified instructor must sign the form where indicated to verify completion of training, or you may submit copies of certificates of completion from classes attended.

FEES: A single renewal fee (plus late fees if applicable) renews all certifications held for a renewal period. To renew your certification(s) through 10/31/2013, pay the following:

Certification Expiration	Pay this Amount	Additional Information
10/31/2012	$127.50	Postmarked 11/1/12-11/30/12. Includes a renewal fee of $85.00 plus a late fee of
		$42.50
	$170.00
		Postmarked on or after 12/1/12. Includes a renewal fee of $85.00 plus a late fee
		of $85.00

Certificates Renewing: Please check the appropriate box for each certificate to be renewed and supply C.E. documentation required. Submit the NON-REFUNDABLE renewal fee, and late fee if applicable (see Page 1 for fees). Incomplete applications and insufficient continuing education documentation may result in application for renewal being denied.

	Structure Fire Protection		□ Basic	□ Intermediate	□ Advanced	□ Master
	Aircraft Rescue Fire		□ Basic	□ Intermediate	□ Advanced	□ Master
	Protection
	Marine Fire Protection		□ Basic	□ Intermediate	□ Advanced	□ Master
	Fire Inspector		□ Basic	□ Intermediate	□ Advanced	□ Master
	Arson Investigator		□ Basic	□ Intermediate	□ Advanced	□ Master
	Fire Investigator		□ Basic	□ Intermediate	□ Advanced	□ Master
	Fire Service Instructor		□ Level I	□ Level II	□ Level III	□ Level III Master
	Fire Officer I		□ Basic
	Fire Officer II		□ Basic
	Hazardous Materials		□ Basic
	Technician
	Driver/Operator -Pumper		□ Basic

My signature below certifies the following:

-The attached continuing education documentation meets the requirements in Chapter 441 of the Commission's Standards Manual and that you are aware that you must maintain your continuing education records for 3 years.

-You have not been convicted of a crime (other than minor traffic offenses) since you became certified or last renewed. If you have been convicted, attach an explanation regarding the date of conviction, original charge, jurisdiction, disposition and circumstances surrounding the offense.

-If you are renewing your Arson Certificate, your signature also certifies that you hold a valid peace officer license and that you are commissioned as a law enforcement officer. If the entity that is holding your commission as licensed law enforcement officer has changed, you must complete the attached confirmation of commission (TCFP -004) form. If you are no longer licensed and commissioned as a law enforcement officer and you are certified as an Arson Investigator, you cannot renew your arson certification.

Signature of Applicant:

Date:

Purpose: This form is to be utilized by all individuals (who are not employed by a regulated entity) requesting renewal of any certification with the commission.

Date Received: Reserved for agency use.

Date Approved: Reserved for agency use.

Approved By: Reserved for agency use.

Certification No./Discipline Code: Reserved for agency use.

Social Security No. or PIN: Provide either the applicant’s social security number or the personal identification number assigned to the applicant by the commission.

Last Name: The applicant’s last name.

Suffix: Examples: Jr., Sr., III, etc.

First Name: The applicant’s first name.

Middle Name or Initial: The applicant’s middle name or middle initial (if the applicant has one).

Home Address of Applicant: Street, city, state and zip code information.

Phone Number: The applicant’s home, work and/or cell phone numbers

Email: The applicant’s email address (if available)

Continuing Education: You must complete 20 hours of continuing education to renew all of your certificates. (If you have a Hazmat Technician certificate, you must complete an additional 10 hours, for a total of 30 hours). C.E. must have been completed within the past 12 months of the expiration date of your certification. If you completed a commission approved academy in the 12 months prior to your expiration date, a copy of that certificate of completion would be acceptable documentation of C.E.

NOTE: For this cycle CE must be completed after May 1, 2010 (if your certification expires 4/30/2011).

There are two types of continuing education: "Track A Training" is a repeat of any basic curriculum in which you hold your certification. The commission will only count four hours of "Track A" training in any one subject.

Individual certificate holders can document their CE by sending in Form TCFP-010, Continuing Education Documentation Form. Please note that the commission-certified instructor who taught the classes must sign the form.

The commission also accepts copies of "certificates of completion" from websites or certified training facilities. The "certificate of completion" must have the name and signature of the commission-certified instructor.

"Track B Training" is training that is intended to develop new skills. Examples of "Track B" training are National Fire Academy (NFA) courses, fire service-related seminars, or college courses in fire science. Submit copies of "certificates of completion" from these courses to document "Track B" courses. (The commission will also accept copies of official transcript as documentation of college courses in fire science).

********DO NOT SUBMIT INSTRUCTIONS WITH APPLICATION********

Certificates Renewing: Check the box(s) for all certification(s) that the applicant holds. All requests for certification renewal must be accompanied by the required Continuing education documentation. Any application that is received without the required documentation will be considered incomplete. Incomplete applications will be denied.

Signature of Applicant/Date: The applicant’s legal signature with the date the applicant signed the form. This is required to attest that the individual has read what their signature is certifying, the accuracy of the information and to verify that you have not been convicted of a crime other than minor traffic offenses since you became certified or last renewed. If you have been convicted of a crime, you must report it to the commission within 14 days of final conviction.