REQUEST FOR DUPLICATE CERTIFICATION CERTIFICATE

NOTE:

Certifications issued with an IFSAC gold seal cannot be duplicated due to the unique number associated with the seal and the specific certification. Only those certifications that are issued with an ProBoard seal and number can be duplicated.

CREDIT CARD PAYMENTS

Please complete the form, upload relevant documents, select payment type as "Electronic Payment" and then select "Checkout" button.
Effective January 1, 2010, applicants requesting duplicate certificates will be charged a fee of $7.50.

MAIL-IN APPLICATION

Please complete the form and select Payment Type as "Mail-In Application"and then select "Submit" button.
Enclose a check or money order with the printed application (Payable to Commonwealth of PA).
Do not add documents, Please mail with your completed form and fee.

First Name

Last Name

SSN# (Last Four Digits)

Date Of Birth

Street Address

City

County

Home Phone

State

Zip

Alternate Phone

IFSAC Certificate

ProBoard Certificate

Instructor Card

Additional Document

Please Select the Level Requested
1	Airport Firefighter	18	Driver/Operator – Aerial
19	Driver/Operator – Mobile Water Supply	17	Driver/Operator – Pumper
8	Fire Inspector	4	Fire Instructor I
5	Fire Instructor II	9	Fire Investigator
6	Fire Officer I	7	Fire Officer II
2	Firefighter I	3	Firefighter II
10	HazMat Awareness	13	HazMat Incident Commander
11	HazMat Operations	12	HazMat Technician
14	Incident Safety Officer	16	Industrial Fire Brigade - Advanced Exterior
15	Industrial Fire Brigade - Incipient	30	Juvenile Firesetter Intervention Specialist I
31	Juvenile Firesetter Intervention Specialist II	28	Public Fire/Life Safety Educator I
29	Public Fire/Life Safety Educator II	25	Rescue Technician – Confined Space
23	Rescue Technician – Rope	26	Rescue Technician – Structural Collapse
27	Rescue Technician – Surface Water	24	Rescue Technician – Trench
20	Rescue Technician – Vehicle/Machinery	21	Rescue Technician – Vehicle/Machinery I
22	Rescue Technician – Vehicle/Machinery II

PaymentType

TotalAmount