CPBM Student Application Form - Pennsylvania Prescribed Fire Council

2026 Certified Prescribed Burn Manager - Student Application Form

Please have all prerequisite burns completed prior to the course start date.

"*" indicates required fields

Course Name

Course Dates

Course Location

Nominee First Name*

Nominee Middle Initial*

Nominee Last Name*

Date*

Street Address*

City*

State*

Zip Code*

Phone*

Email Address*

Nominee Type*

Why are you interested in this course?*

Prerequisite Training*

Past Qualifications*

Upload S130/190 and L180 documents*

Drop files here or

Max. file size: 100 MB.

Upload I-100 and I-700 documents*

Drop files here or

Max. file size: 100 MB.

Experience Log if applicable

Drop files here or

Max. file size: 100 MB.

Additional Remarks

Please note that spaces are limited. July 31, 2026 cutoff date to apply. The Certification Board will select students. We will notify selected students as soon as possible so they can make logistical arrangements. Selected students will be emailed invoice of $100 to pay which will be due by August 31st. Students not selected for this class may be selected for the next class when the date is set.

Applicants of Certified Prescribed Burn Manager class shall be entitled to a full refund of course fee if Pennsylvania Prescribed Fire Council is notified within thirty (30) business days of the course date. Cancellations made less than thirty (30) business days from the course date shall entitle the applicant to a fifty percent (50%) refund of course fees. No refunds shall be made for cancellations less than two (2) business days before the course date.

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October 3rd Interest

I am interested in the October 3rd half day workshop. The time will be set aside for additional instruction and guided burn plan writing.

Understanding Certification*

Student hereby certifies that the information provided in this CPBM Nomination Form is true and accurate to the best of their knowledge. Please note that The Pennsylvania Prescribed Fire Council assumes no responsibility for personal injury or loss or destruction of property arising from participation by Student in this training course, or Prescribed Fires. (PLEASE CHECK THIS BOX NOTING THAT YOU HAVE READ AND UNDERSTAND THIS.)