Funding Assistance Program (FAP) Online Purchase Inquiry, F-03446 (06/2026)

This form can be used to check the eligibility of the use of FAP funds towards an expense that may not align with the FAP Purchasing Guide (P-02422A). The use of funds towards the purchase of an ambulance or an ambulance remount are an eligible use of funds. You must complete this form for any other type of potential vehicle purchase. Please allow up to two business days for a response.

1. Provide the following information for your service. *This question is required.

Service name

Service address

2. Are you a service director? *This question is required.

3. Describe your role in or relationship to your service. *This question is required.

3. Provide the following contact information. *This question is required.

First name

Last name

Email address This question requires a valid email address.

Phone number

3. Select your purchase inquiry type. *This question is required.

3. Select vehicle type. *This question is required.

3. Provide the year, make, and model of the vehicle. *This question is required.

3. Approximate cost of vehicle *This question is required. This question requires a valid currency format.

3. Expense name *This question is required.

3. Approximate cost *This question is required. This question requires a valid currency format.

3. Describe the inquiry in detail. Provide as much information as possible and include any links to sites if applicable. *This question is required.

3. Explain how this purchase will support and improve your Emergency Medical Service. If applicable, include circumstances unique to your service area such as geography, population changes, or other factors. *This question is required.

3. Please provide any additional information not already mentioned in this inquiry.

3. Provide any supporting documents related to this request.

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