ࡱ> ?A>q` bjbjqPqP 4"::  $#2     """""""$B$h&""  "666   "6"66"_"  ~Q+"""0#3",:'X:'_":'_"0D6 "", # D CONNECTICUT FAIR PLAN* ANTI-ARSON COMMITTEE P. O. BOX 280200 EAST HARTFORD, CT 06128-0200 SCHOLARSHIP FUND BACKGROUND: The FAIR Plan Anti-Arson Committee has established a scholarship fund from which stipends will be awarded in amounts up to $250, in any calendar year per individual. The Committee reserves the right to exceed that amount in exceptional cases. PURPOSE: The scholarship program is designed to subsidize fire investigators, fire safety professionals, police and prosecutors who would not otherwise be able to meet the costs of attending courses or seminars relating to the prevention, investigation or prosecution of arson fires. ELIGIBILITY: Candidates must be employed by, or be certified volunteers serving in state or local fire marshal offices, fire or police departments or state judicial districts. CRITERIA: Courses or seminars relating to fire prevention, fire investigation or the prosecution of arson must be offered by an accredited educational institution, professional organization or deemed otherwise acceptable as credit towards the State of Connecticut requirement of 90 hours in-service training to maintain Bureau of State Fire Marshal Certification. PROCEDURE: Submit completed application and descriptive course information to: Connecticut FAIR Plan, Anti-Arson Committee, P. O. Box 280200, East Hartford, CT 06128-0200 Representing the Insurance Industry CONNECTICUT FAIR PLAN ANTI-ARSON COMMITTEE SEMINAR STIPEND APPLICATION (Please Print or Type) NAME: ____________________________________________________________________ ADDRESS: _________________________________________________________________ TELEPHONE (H):______________ (W): ____________ SOC.SEC.NO.:_________________ HIGHEST FORMAL EDUCATION: HIGH SCHOOL: _____ COLLEGE: ____ DEGREE: _____ CERTIFIED__________________________________________________________________ EMPLOYER: _____________________________________________ # OF YRS:__________ ADDRESS: ______________________________________________________________ (___) FIRE DEPARTMENT (___) FIRE MARSHAL (___) FIRE INVESTIGATOR (___) STATE FIRE MARSHAL (___) PROSECUTOR (___) OTHER: ______________ PRESENT POSITION:___________________________________ # OF YRS:_________ SEMINAR YOU PLAN TO ATTEND: _____________________________________________ LOCATION: _____________________________________________________________ DATE: ________ REGISTRATION FEE: _______ AMOUNT REQUESTED: __________ DO YOU HAVE APPROVAL OF YOUR SUPERVISOR, DEPARTMENT, OR AGENCY TO ATTEND THE SEMINAR? (___) YES (___) NO APPLICANT MUST ENROLL OR PLAN TO ATTEND AN ACCREDITED SEMINAR OR COURSES IN FIRE PREVENTION, FIRE AND ARSON INVESTIGATION, AND RELATED SUBJECTS. PLEASE ATTACH A SEMINAR BROCHURE, FLYER, OR A BRIEF DESCRIPTION WITH THIS APPLICATION. _____________________________________ ____________________________________ SIGNATURE OF APPLICANT SIGNATURE OF SUPERVISOR RETURN APPLICATION TO: CONNECTICUT FAIR PLAN ANTI-ARSON COMMITTEE P. O. BOX 280200 EAST HARTFORD, CT 06128-0978 COMMITTEE ACTION: (__) DISAPPROVED (__) APPROVED AMOUNT_________________ _oq  % & ] _ ǷwgwXMho#iho#iOJQJhyJh6CJOJQJaJhIrLh65CJOJQJaJh6CJOJQJaJh`h6CJOJQJaJh65>*OJQJhyJh65>*OJQJhyJh65OJQJh`h65CJOJQJaJh6OJQJh9OJQJhtUOJQJho#i5>*OJQJho#iho#i5>*OJQJho#iOJQJ,=[\]^_pq& ^ u v & ^ " K `^``gdo#i ^`gdo#igdo#i$a$gdo#iK L  Y   P n o p q r s $a$gd6gd6p^pgd6 `^``gdo#i ^`gdo#i DE*+wxbcPQgd6$a$gd66noXY3N ^`gdo#i &d P gd6gd621h:p6/ =!"#`$`% @@@ NormalCJ_HaJmH sH tH DA@D Default Paragraph FontVi@V  Table Normal :V 44 la (k@(No List ",=[\]^_pq&^uv&^"KLY PnopqrsDE*+wxbc  P Q 6 n o  X Y  3 N 00000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000,=[\]^_pq&^uv&^"KLY Pnopqrs3 N I00I00I00I00I00I00I00I00I00I00I00I00I00I00I00I00I00I00I00I00I00I00I00I00I00I00I00I00I00I00I00I00I00I00I00I00I00I00I00I00I00I00I00{0a{0{0@(xt8{0{0K00 K   8@0(  B S  ? /u/\5u/4u/ m/<1u/Tu/̶K/u/K/tK/u/K/K/tDE/DE/u/u/\m/m/M/M/et/*urn:schemas-microsoft-com:office:smarttags PostalCode8*urn:schemas-microsoft-com:office:smarttagsCity= *urn:schemas-microsoft-com:office:smarttags PlaceType= *urn:schemas-microsoft-com:office:smarttags PlaceName t         _a&+^h"-!Yd  = S 33333333333333333333%&VV]_K  rMa  ^ `OJPJQJ^Jo(  ^ `OJQJ^Jo(hHoxx^x`OJQJo(hHHH^H`OJQJo(hH^`OJQJ^Jo(hHo^`OJQJo(hH^`OJQJo(hH^`OJQJ^Jo(hHoX X ^X `OJQJo(hHr>        { 6Go#i9tU@ p@UnknownGz Times New Roman5Symbol3& z Arial?5 z Courier New;Wingdings"h#f#f  $24 2QHX)?o#i2CONNECTICUT FAIR PLAN* Karen CarelliChip Janiszewski Oh+'0  (4 T ` l xCONNECTICUT FAIR PLAN*Karen CarelliNormalChip Janiszewski3Microsoft Office Word@G@N%Sz@o@m4 ՜.+,0  hp  CT Fair Plan  CONNECTICUT FAIR PLAN* Title  !"#$%&'()*+,-/012345789:;<=@Root Entry F~QBData 1TableJ'WordDocument4"SummaryInformation(.DocumentSummaryInformation86CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q