Arson Canine - Hydrocarbon Detector Dog

School Scholarships Funded by State Farm Insurance Companies®
To the chief executive of a law enforcement or fire service agency having criminal enforcement investigation authority for the crime of arson, please:

1. Print the application.
2. Complete the application.
3. Attach a letter describing the magnitude of the arson problem in your jurisdiction, also certifying that the applicant is a full-time member of the agency you represent and that the agency will be responsible for the care and recertification of the canine once the program is completed. Copy of certificate is not required.
4. Attach a current resume from the applicant describing his/her job and training history.

Submit the application and appropriate attachments to:

Arson Dog Program (B-4)
State Farm Insurance Companies
One State Farm Plaza
Bloomington, IL 61710-0001

Phone: 1-309-766-2259
Fax: 1-309-766-2259
E-mail: dawn.fones.cv9s@statefarm.com

Should you have further questions, please write, call or e-mail.

Name:
(first/middle initial/last)

Full Title, Rank or Position:

Name of Employing Agency:
(Include Parent Organization Where Applicable):

Agency Address:
street:
city:
state:
zip:

Agency Phone:

Fax:

E-mail:

Home Address:
street:
city:
state:
zip:

Home Phone:

Applicant must complete the following

I, (write your name here)
release the sponsoring agency and any other department/agency officially connected or associated with this training program from any liability in the case of illness or accidents.

Signature:

Date:

If course is filled, I wish to be placed on the waiting list.
Yes No

I am a full-time employee for the above agency.
Yes No

Please attach a breakdown of the fire calls for two years previous, excluding EMS runs.

Is there an accelerant dog in your area?

Yes ____ No ___ Don't know ____

If yes, where: _____________________________

Agency/department must be completed:

The (Agency/Department's Name)
approves this applicant for training and releases the sponsoring agency and any other department/agency officially connected or associated with this training program from any liability in the case of illness or accidents. The agency will be responsible for recertification and maintenance for K-9 once acquired.