Florida Department of Agriculture and Consumer Services
Florida Forest Service
PRESCRIBED FIRE CORRESPONDENCE COURSE
APPLICATION
ADAM H. PUTNAM Florida Administrative Code 5I-2.006(2)(c)
COMMISSIONER Telephone: (850) 488-6111
Contact Information1
Last Name* Cummings First Name* James MI. R
Street* 23641 Estero Court City* Land O' Lakes
State* FL Zip Code* 34639 Email *
[email protected]Personal Telephone Number with Area Code Business Telephone Number with Area Code*
(813)855-9437 (813)907-9500
Have you ever received an acreage authorization If Yes, please provide your customer number
from the FFS? Yes No ✔
Burn History (acreage burns only)2
Were you in charge of this
Date of Burn Type of Burn (agriculture, silviculture, wildlife, etc.)
burn Yes/No?
5/13/14 Fuel Reduction/Ecological Burn (55 acres) No
5/07/14 Fuel Reduction/Ecological Burn (55 acres) No
4/23/14 Fuel Reduction/Ecological Burn (10 acres) No
4/09/14 Fuel Reduction/Ecological Burn (271 acres) No
3/20/14 Fuel Reduction/Ecological Burn (122 acres) No
3/19/14 Fuel Reduction/Ecological Burn (109 acres) No
3/10/14 Fuel Reduction/Ecological Burn (321 acres) No
3/04/14 Fuel Reduction/Ecological Burn (165 acres) No
2/25/14 Fuel Reduction/Ecological Burn (140 acres) No
1/13/14 Fuel Reduction/Ecological Burn (200 acres) No
Please fill out this form and email it to the course coordinator. Once this form has been received and processed,
you will receive a package in the mail with course materials and an invoice.
Once you have received the package and are ready to begin the online portion of the course, please notify the
course coordinator so they can activate your online account.
*Required Fields
1 – Contact Information – Please provide your legal name. The address must be able to receive mail from the US
Postal Service
2 – Burn History – Please include the most recent burns which for which you were a participant or conducted. A
minimum of three burns must be provided to be eligible for this course.
FDACS-11621
