Form FDACS-03586 "Lp Gas Continuing Education Course Approval Application" - Florida

What Is Form FDACS-03586?

This is a legal form that was released by the Florida Department of Agriculture and Consumer Services - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2019;
  • The latest edition provided by the Florida Department of Agriculture and Consumer Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form FDACS-03586 by clicking the link below or browse more documents and templates provided by the Florida Department of Agriculture and Consumer Services.

ADVERTISEMENT
ADVERTISEMENT

Download Form FDACS-03586 "Lp Gas Continuing Education Course Approval Application" - Florida

1311 times
Rate (4.6 / 5) 79 votes
Florida Department of Agriculture and Consumer Services
Division of Consumer Services
Please return completed
LP GAS
application to:
CONTINUING EDUCATION COURSE
FDACS
2005 Apalachee Parkway
APPROVAL APPLICATION
Tallahassee, FL 32399-0800
NICOLE “NIKKI” FRIED
Chapter 527, Florida Statutes
Rule 5J-20.004, Florida Administrative Code
COMMISSIONER
APPLICATION TYPE
Course Application / Update
Course Renewal
PROVIDER INFORMATION
Individual / Company Name:
Provider Number(s):
(
)
-
(
)
-
Telephone
Facsimile
Point of Contact:
Mailing Address
:
(If applicable please include suite and/or unit numbers.)
City:
State:
Zip Code:
-
Email Address:
Website:
COURSE INFORMATION
Is this a new course?
Yes
No
Course #:
If this is not a new course, has the course changed?
No
Yes
(If yes, please include an outline of the changes on a separate sheet.)
Title of Course, Workshop, or Seminar:
Number of Classroom Hours:
Does this course meet the continuing education requirement set forth in Rule 5J-20.062, F.A.C.?
Yes
No
REQUIRES SIGNATURE OF PROVIDER POINT OF CONTACT
The above information is complete and truthful to the best of my knowledge.
Applicant Signature: _________________________________________________ Date: __________________
FDACS–03586 05/19
Page 1 of 2
Florida Department of Agriculture and Consumer Services
Division of Consumer Services
Please return completed
LP GAS
application to:
CONTINUING EDUCATION COURSE
FDACS
2005 Apalachee Parkway
APPROVAL APPLICATION
Tallahassee, FL 32399-0800
NICOLE “NIKKI” FRIED
Chapter 527, Florida Statutes
Rule 5J-20.004, Florida Administrative Code
COMMISSIONER
APPLICATION TYPE
Course Application / Update
Course Renewal
PROVIDER INFORMATION
Individual / Company Name:
Provider Number(s):
(
)
-
(
)
-
Telephone
Facsimile
Point of Contact:
Mailing Address
:
(If applicable please include suite and/or unit numbers.)
City:
State:
Zip Code:
-
Email Address:
Website:
COURSE INFORMATION
Is this a new course?
Yes
No
Course #:
If this is not a new course, has the course changed?
No
Yes
(If yes, please include an outline of the changes on a separate sheet.)
Title of Course, Workshop, or Seminar:
Number of Classroom Hours:
Does this course meet the continuing education requirement set forth in Rule 5J-20.062, F.A.C.?
Yes
No
REQUIRES SIGNATURE OF PROVIDER POINT OF CONTACT
The above information is complete and truthful to the best of my knowledge.
Applicant Signature: _________________________________________________ Date: __________________
FDACS–03586 05/19
Page 1 of 2
General Information
There is no fee to submit this application.
If you have any questions or need assistance in completing this application, please contact the Florida Department of
Agriculture and Consumer Services Bureau of Compliance at (850) 921-1600.
Before submitting an application, be certain that the application is completely filled out, that all questions are answered
truthfully and that all the information requested is furnished. Please type or print in ink. Applicants are cautioned to read
questions thoroughly.
If you are applying to qualify more than one course, you must fill out a form for each course
and provide supporting documentation for each course.
COURSE TITLE
As it is to appear on any advertisements or in internal company records.
COURSE DESCRIPTION
Shall relate to the inspection and technical skills required for students.
COURSE OBJECTIVES
Clearly and specifically state what skills or knowledge the applicants should be able to demonstrate when the course is
successfully completed.
METHOD OF COURSE PRESENTATION
Shall describe how the content will be presented.
SUBMIT A COPY OF COURSE MATERIALS
The outside vendor shall review the course content annually and immediately notify the department of any revisions to
course materials or documents and shall provide copies of such revisions or documents to the department for review.
The approval for such courses will expire five years from the approval date. Courses must be reapproved in order
to be eligible for continuing education credits.
FDACS–03586 05/19
Page 2 of 2

Browse Form FDACS-03586 by Year

Page of 2