Appendix E Dec 2017
REQUEST FOR RECIPROCITY APPLICATION
Name Social Security #
Address Date of Birth
(Last Four Digits)
City State Zip
County Home Phone Alternate Phone
RECIPROCITY LEVEL REQUESTED
Firefighter I Driver/Operator - Pumper
Firefighter II Driver/Operator - Aerial
Fire Service Instructor I Driver/Operator - Mobile Water
Fire Service Instructor II Rescue Technician – Vehicle/Machinery
Fire Officer I Rescue Technician – Vehicle/Machinery I
Fire Officer II Rescue Technician – Vehicle/Machinery II
Airport Firefighter Rescue Technician – Rope
Fire Investigator Rescue Technician – Confined Space
Fire Inspector I Rescue Technician – Structural Collapse
HazMat Awareness Rescue Technician – Trench
HazMat Operations Rescue Technician – Surface Water
HazMat Technician Juvenile Firesetter Intervention Specialist I
HazMat Incident Commander Juvenile Firesetter Intervention Specialist II
Incident Safety Officer Industrial Fire Brigade - Incipient
Public Fire & Life Safety Educator I Industrial Fire Brigade - Advanced Exterior
Public Fire & Life Safety Educator II
NOTE: MUST BE A PENNSYLVANIA RESIDENT and PROOF OF CERTIFICATION MUST BE ATTACHED TO THIS APPLICATION
Effective January 1, 2010, applicants requesting reciprocity will be charged a fee of $15.00; PLUS $5.00 per level requested. Payment must be made in the form of a check or money order, payable to the
“Commonwealth of Pennsylvania”. Please refer to instruction sheet on the following page for additional information.
Mail application to: Pennsylvania State Fire Academy Attn: Certification Program-Reciprocity
1150 Riverside Drive Lewistown, PA 17044
Appendix E Dec 2017
REQUEST FOR RECIPROCITY APPLICATION INSTRUCTIONS 1. Complete application
2. Attached copies of Certification Certificates (IFSAC or Pro-Board). 3. Please make sure to enclose a check or money order with your application
(Payable to Commonwealth of PA)
Note:
• Certification Reciprocity will not be given for completion of training. We will only issue for National Certifications.
• We cannot issue reciprocity for a level that we are not accredited or before a date that we were
accredited. (See list below)
Table Revised Feb 2017
Level /NFPA Standard Pro-Board Accredited
IFSAC Accredited
Pro-Board
Date
Accredited
IFSAC
Date
Accredited
HazMat Awareness - 472 X X 2003 7/26/08
HazMat Operations - 472 X X 2003 7/26/08
HazMat Technician - 472 X X 2003 5/31/11
HazMat Incident Commander X X 10/21/14 9/20/14
Fire Fighter I - 1001 X X 1985 7/26/08
Fire Fighter II - 1001 X X 1985 7/26/08
Driver/Operator - Pumper - 1002 X X 2003 9/11/09
Driver/Operator - Aerial - 1002 X X 2008 9/11/09
Driver/Operator – Mobile Water Supply 1002 X X 2008 9/11/09
Airport Fire Fighter - 1003 X X 2003 9/11/09
Fire Officer I - 1021 X X 1996 7/26/08
Fire Officer II - 1021 X X 1996 7/26/08
Fire Investigator I - 1033 X X 1997 10/13/14
Fire Inspector I - 1031 X X 2009 11/10/09
Fire Service Instructor I - 1041 X X 1992 6/29/09
Fire Service Instructor II - 1041 X X 1994 6/29/09
Incident Safety Officer - X X 3/30/15 12/29/14
Pub. Fire & Life Safety Educator I - 1035 X X 2008 6/29/09
Pub. Fire & Life Safety Educator II - 1035 X X 1/19/17 7/31/16
Juvenile Firesetter Intervention Specialist I X X 2008 6/29/09
Juvenile Firesetter Intervention Specialist II X X 3/30/15 12/29/14
Confined Space Rescue Tech - 1006 X X 2005 ------------
Confined Space Rescue Tech Levels I/II X X 7/27/10 8/19/10
Rope Rescue Tech – 1006 X X 2003 -------------
Rope Rescue Tech Level I/II X X 7/27/10 5/31/11
Structural Collapse Rescue Tech – 1006 X X 2008 ------------
Structural Collapse Rescue Tech Level I/II X X 7/27/10 8/30/10
Surface Water Rescue Tech - 1006 X X 2008 Nov 2009
Surface Water Rescue Tech Level I/II X X 7/27/10 8/20/10
Trench Rescue Tech – 1006 X X 2004 -------------
Trench Rescue Tech Levels I/II X X 7/27/10 8/9/10
Vehicle & Machinery Rescue Tech – 1006 X X 2003 --------------
Vehicle & Machinery Rescue Tech Level I X X 7/27/10 5/31/11
Vehicle & Machinery Rescue Tech Level II X X 7/27/10 5/31/11
Incipient – Industrial Fire Brigade - 1081 X X 10/22/10 6/16/2011
Advanced Exterior – Industrial Fire Brigade -1081 X X 1/27/11 6/16/2011