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

Form FDACS-03586 is a Florida Department of Agriculture and Consumer Services form also known as the "Lp Gas Continuing Education Course Approval Application". The latest edition of the form was released in August 1, 2018 and is available for digital filing.

Download a fillable PDF version of the Form FDACS-03586 down below or find it on Florida Department of Agriculture and Consumer Services Forms website.

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

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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
ADAM H. PUTNAM
Tallahassee, FL 32399-0800
COMMISSIONER
Chapter 527, Florida Statutes
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 CE requirement set forth in Rule 5J-20.062, F.A.C.?
Yes
No
ATTEST STATEMENT
REQUIRES SIGNATURE OF PROVIDER POINT OF CONTACT
I affirm that I have provided the above information completely and truthfully to the best of my knowledge.
Applicant Signature: _________________________________________________ Date: __________________
FDACS–03586 08/18
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
ADAM H. PUTNAM
Tallahassee, FL 32399-0800
COMMISSIONER
Chapter 527, Florida Statutes
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 CE requirement set forth in Rule 5J-20.062, F.A.C.?
Yes
No
ATTEST STATEMENT
REQUIRES SIGNATURE OF PROVIDER POINT OF CONTACT
I affirm that I have provided the above information completely and truthfully to the best of my knowledge.
Applicant Signature: _________________________________________________ Date: __________________
FDACS–03586 08/18
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 bureau of any revisions to course
materials or documents and shall provide copies of such revisions or documents to the bureau 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 08/18
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