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               NWCG Interagency Training Nomination

Part I Registration Completion is required. Submit one form per course.

Course Name                                                                                            FOR COURSE SPONSOR/HOST USE ONLY

________________________________________________________________    PRIORITY __________OF __________

Course Date_________________ Course Location_______________________ Course Tuition (if required)________

Nominees Name___________________________________________________ Date Submitted___________________

Working Job Title____________________________________________ DG. IAMS, OR FAX Address____________

Sponsor or Agency (Name, Address)                                                                    Nominees Address (if different)

Telephone No. Comm:                                                                                          Telephone No. Comm:

FTS: (if different)                                                                                                  FTS:

I will notify the course coordinator/Training Center if I am unable to attend.

PART II Experience Complete or attach Qualification & Experience Record printout, if required.

Do you meet all of the NWCG or additional Agency PREREQUISITES for the course? (Reference NWCG 310-1 or

Agency Manual). YES/NO

List your past experience pertinent to this course:

List training completed and dates pertinent to this course:

Nominees Signature_________________________________________________________

Remarks

Part III Financial Complete if required.

Attach additional financial forms as stipulated by the Training Announcement or required by the Training Centers.  Make payments to the Sponsoring Agency.

Management Code or Charge Code Number ____________________________________________________________

This agreement constitutes authority for the Vendor (Sponsoring Agency) to submit a bill to the above agency.

 Authorizing Signature (Agency Administrator)___________________________________________ Date__________