Patch Orders - Office of State Fire Academy

CREDIT CARD PAYMENTS

Please complete the form, upload relevant documents, select payment type as "Electronic Payment" and then select "Checkout" button.
Certification Keystone patches and/or bars: Attach proof of your certification(s) to this form.
State Fire Academy Local Level Instructor Keystone Patch: Attach copy of your instructor card.

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

Patch Description	Rate/Patch	Qty
3	Airport Firefighter Bar	1.00
2	Certification Keystone 'NPQS & IFSAC'	3.00
1	Certification Keystone 'NPQS'	3.00
26	Driver/Operator – Aerial Bar	1.00
24	Driver/Operator – Mobile Water Supply Bar	1.00
25	Driver/Operator – Pumper Bar	1.00
10	Fire Inspector Bar	1.00
6	Fire Instructor I Bar	1.00
7	Fire Instructor II Bar	1.00
11	Fire Investigator Bar	1.00
8	Fire Officer I Bar	1.00
9	Fire Officer II Bar	1.00
4	Firefighter I Bar	1.00
5	Firefighter II Bar	1.00
13	HazMat Awareness Bar	1.00
14	HazMat Operations Bar	1.00
15	HazMat Technician Bar	1.00
12	Incident Safety Officer	1.00
32	Industrial Fire Brigade – Advanced Exterior	1.00
31	Industrial Fire Brigade – Incipient	1.00
29	Juvenile Firesetter Intervention Specialist I Bar	1.00
30	Juvenile Firesetter Intervention Specialist II Bar	1.00
27	Public Fire/Life Safety Educator I Bar	1.00
28	Public Fire/Life Safety Educator II Bar	1.00
21	Rescue Technician – Confined Space Bar	1.00
19	Rescue Technician – Rope Bar	1.00
22	Rescue Technician – Structural Collapse Bar	1.00
23	Rescue Technician – Surface Water Bar	1.00
20	Rescue Technician – Trench Bar	1.00
16	Rescue Technician – Vehicle/Machinery Bar	1.00
17	Rescue Technician – Vehicle/Machinery I Bar	1.00
18	Rescue Technician – Vehicle/Machinery II Bar	1.00
33	State Fire Academy Local Level “Instructor” Keystone Patch	3.00

PaymentType

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