FireSmart Community Recognition Application Form

Fields marked with * are required.

The community/neighborhood of , in the province/territory of , hereby applies to be officially recognized and designated as a qualified participant in the FireSmart Canada Community Recognition Program for the year. Members of the community have adopted the following FireSmart Communities recognition program standards:

1. Formed a FireSmart Board

2. Completed a Community Assessment Report

YesNo

3. Created a FireSmart Community Plan

YesNo

4. Held a FireSmart Event

YesNo

5. Invested at least $2/capital in FireSmart Events

6. Please provide the following contact information

Local Fire Chief Contact

Additional Fire Advisor

7. Application Submitted by

Recognition materials will be sent to this person on approval of application