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DocuSign Envelope ID:79C5D167-B6CA-4E59-B4AC-AA38CC1B20BD <br /> (Attachment 2) <br /> DESIGNATION OF TRAINING OFFICER <br /> Agency Credentialing Guidelines require that the Agency indicate their <br /> designation of the EMS Training Officer. <br /> Agency Name: <br /> Date: <br /> The individual(s) who will provide EMS Training Officer services under the Agency Credentialing <br /> Guidelines shall be as follows: <br /> I. Agency EMS Training Officer: <br /> Contact Information <br /> Preferred Method of Contact: <br /> IL Back-Up Training Officer: <br /> (Optional) <br /> Contact Information <br /> Preferred Method of Contact: <br /> III. If applicable,please attach EMS Level I Instructor Certificate and any other Instructor certificates <br /> IV. Agency Approval <br /> Department Chief: <br /> (Signature) (Date) <br /> (Printed Name) <br /> FOR OCES USE ONLY <br /> Received by: Date: <br />