Patch Orders - Office of State Fire Academy

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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 bars may only be purchased when the certification was issued to the individual(s) through the OSFC/PSFA Certification Program. Attach proof of your certification 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	3.00
2	Certification Keystone 'NPQS & IFSAC'	5.00
1	Certification Keystone 'NPQS'	5.00
26	Driver/Operator – Aerial Bar	3.00
24	Driver/Operator – Mobile Water Supply Bar	3.00
25	Driver/Operator – Pumper Bar	3.00
10	Fire Inspector Bar	3.00
6	Fire Instructor I Bar	3.00
7	Fire Instructor II Bar	3.00
11	Fire Investigator Bar	3.00
8	Fire Officer I Bar	3.00
9	Fire Officer II Bar	3.00
4	Firefighter I Bar	3.00
5	Firefighter II Bar	3.00
13	HazMat Awareness Bar	3.00
14	HazMat Operations Bar	3.00
15	HazMat Technician Bar	3.00
12	Incident Safety Officer	3.00
32	Industrial Fire Brigade – Advanced Exterior	3.00
31	Industrial Fire Brigade – Incipient	3.00
29	Juvenile Firesetter Intervention Specialist I Bar	3.00
30	Juvenile Firesetter Intervention Specialist II Bar	3.00
27	Public Fire/Life Safety Educator I Bar	3.00
28	Public Fire/Life Safety Educator II Bar	3.00
21	Rescue Technician – Confined Space Bar	3.00
19	Rescue Technician – Rope Bar	3.00
22	Rescue Technician – Structural Collapse Bar	3.00
23	Rescue Technician – Surface Water Bar	3.00
20	Rescue Technician – Trench Bar	3.00
16	Rescue Technician – Vehicle/Machinery Bar	3.00
17	Rescue Technician – Vehicle/Machinery I Bar	3.00
18	Rescue Technician – Vehicle/Machinery II Bar	3.00
33	State Fire Academy Local Level “Instructor” Keystone Patch	5.00

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