EMI/FCC Independent Study Program College Credit Checklist

Be sure to complete all of the items listed below or your application will be delayed! Make sure you:

Successfully completed your EMI courses prior to submitting your application Download, print and fill out all requested information on the college credit application Verify that the eligible courses that you selected on the application and the courses that you completed are the same Provide payment information in the form of credit card, money order or cashiers check (if paying by Credit Card) Verify the per day charge and withdrawal amounts with your bank or credit card company (if paying by Money Order or Cashiers Check) Make sure the payment document is made payable to Sytel, Inc. and for the exact amount of your credit fee Fax or mail your application to the ISP office for processing

EMI Independent Study Attn: College Credit Dept. 16825 South Seton Avenue Emmitsburg, MD 21727 Fax: (301) 447-1873 Attention College Credit Applicants: Frederick Community College (FCC) will be closed for winter break starting December 19, 2008 and will reopen January 5, 2009. In order to receive your FCC transcript before the end of 2008 your college credit application must be submitted by December 1, 2008.

Updated 11/08

EMI Independent Study Programs

Frederick Community College Application for College Credit Lower division college credit is offered through Frederick Community College at $60 per semester hour, and each course is eligible for 1 semester hour unless otherwise indicated. To apply, select the courses for which you would like credit from the list and complete the requested student information. Please enclose a Money Order, or Visa or MasterCard information for the appropriate amount payable to Sytel, Inc. Personal Checks are not accepted as a form of payment. Students must complete the courses prior to submitting this application for college credit. You do not need to send copies of your course completion certificates. Only courses listed below are eligible for credit. Do not write in additional courses. All applicants are responsible for verifying acceptance of these credits by his or her receiving institution. Completed applications can either be mailed or faxed depending on payment method. If you need assistance please call (301) 4471200, or you may send an email to Independent.Study@dhs.gov

PLEASE ALLOW FOUR WEEKS FOR PROCESSING NO RUSH SERVICE AVAILABLE

Mail to: EMI Independent Study Attn: College Credit Dept. 16825 South Seton Ave. K-211 Emmitsburg, MD 21727 Fax to: (301) 447-1873

SECTION 1

Student Information: Please write clearly; fill in all data fields, & double check for accuracy to avoid processing delays. First Name:_________________________ Middle Initial:_____ Last Name:__________________________ SSN:______-_____-______ Date of Birth:____/____/____ Gender: Female Male

Address:___________________________________ City:_________________ St:_____ Zip:______ Daytime Phone: (_____)_______-__________ Email Address:____________________________________________ Have you applied for credit with us before? YES NO (circle one)
SECTION 2

Signature:_____________________________________________________ Date:_____/_____/_____ Courses Eligible for One Semester Hour

IS-1 (FEM 113): Emergency Manager IS-3 (FEM 115): Radiological Emergency Management IS-5.A(FEM 116): Hazardous Materials, An Intro. IS-7 (FEM 108): A Citizens Guide to Disaster Assistance IS-8.A (FEM 104): Building for the Earthquakes of Tomorrow IS-10 (FEM 109): Animals in Disaster, Module A IS-11 (FEM 110): Animals in Disaster, Module B IS-111 (FEM 138): Livestock in Disaster IS-139 (FEM 141): Exercise Design IS-208 (FEM 128): State Disaster Management IS-230 (FEM 131): Principles of Emergency Management IS-235 (FEM 140): Emergency Planning IS-240 (FEM 132): Leadership & Influence IS-241 (FEM 133): Decision Making & Problem Solving IS-242 (FEM 134): Effective Communication IS-244 (FEM 135): Developing & Managing Volunteers IS-253 (FEM 144): Coordinating Environment & Historic Preservation Compliance IS-271 (FEM 127): Anticipating Hazardous Weather & Community Risk

IS-279 (FEM 105): Retrofitting Flood-Prone Structures IS-288 (FEM 119): The Role of Volunteer Agencies in Emergency Management IS-292 (FEM 139): Disaster Basics IS-301 (FEM 102): Radiological Emergency Response IS-302 (FEM 155): Modular Emergency Response Radiological Transportation Training IS-324 (FEM 122): Community Hurricane Preparedness IS-331 (FEM 146): Intro. to Radiological Emergency IS-340 (FEM 145): Hazardous Materials Prevention IS-346 (FEM 107): Orientation to Hazardous Materials for Medical Personnel IS-362 (FEM 156): Multi-hazard Emergency Planning for Schools IS-386 (FEM 130): Introduction to Residential Coastal Construction IS-393.A (FEM 157): Introduction to Hazard Mitigation IS-394.A (FEM 158): Protecting your Home or Small Business from Disaster IS-630 (FEM 126): Introduction to Public Assistance IS-632 (FEM 136): Debris Operations IS-650 (FEM 143): Building Partnerships with Tribal Gov

Updated 11/08

All of the courses in each combination below must be completed to earn 1 semester hour

IS-100 (FEM 150): IS-200

Introduction to Incident Command System Introduction to Incident Command System for Single Resources & Initial Action Incidents

*Please note that you may use any IS-100 with any IS-200, however FEM 150 can only be obtained once for credit

IS-120.A (FEM 103): An Introduction to Exercises IS-130 Exercise Evaluation and Improvement Planning
*Please note that this is the same credit as IS-120 (FEM 103) and this can only be obtained once for credit

IS- 546 (FEM 154): Continuity of Operations Awareness IS- 547 Introduction to Continuity of Operations IS-700 (FEM 151): National Incident Management System (NIMS), an Introduction IS-702 National Incident Management System (NIMS), Public Information System IS-703 National Incident Management System (NIMS), Resource Management IS-800.A/B (FEM 152):National Response Framework (NRF), and Introduction IS-1900 National Disaster Medical System, Federal Coordinating Center Operations

SECTION 3

Payment Calculation

Total # of Semester Hours: ________

$60.00 = Total Payment: $________

Payment Options: Only those listed below will be accepted (We do not accept personal checks)
Money Order or Cashiers Check Payable to Sytel, Inc.
Visa/MC #_________-_________-_________-__________ exp______/______ Signature:____________________________________________________
* Your credit card statement will reflect a payment made to Sytel Inc. A $25 fee will be assessed for cancellations requested within 24 hours of submissions of
this application. Cancellations will not be granted after 24 hours of application receipt. **If you are using a Check Card or a Debit Card please verify the per day charge and withdrawal amounts with your bank prior to submission.

Your Credit Card Billing Address (your address as it appears on your credit card statement) Name:______________________________________________________________________ Street Address:_______________________________________________________________ City:_________________________________State:____________Zip:__________________
SECTION 4

Transcript Requests I hereby request Frederick Community College to forward an official transcript to the institutions listed below. (You will automatically receive a student copy at your home address. If you wish to have an official copy sent to your home, please put your name and address in the space provided below.)
Signature:_______________________________________ Date:_____/_____/_____ Forward Transcripts To: Institution: _______________________________________ ATTN: __________________________________________ Address: _________________________________________ City: _____________________ST:______ ZIP:__________ Institution: _____________________________________ ATTN: ________________________________________ Address: _______________________________________ City: _____________________ST:_____ZIP:__________
SECTION 5 Updated 11/08