National Wildland Fire Training
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Nomination Form

Remember! Filling out this form DOES NOT submit your nomination. Click the 'Help' button on the right for more information.
Fields with a red border and red asteriskare required.
Course &
Session
Information
Course Code & Name:
RT130 - Fire Safety Refresher
Start & End Dates:
03-15-2017 to 03-15-2017
Location:
Missoula, MT 59808
IQCS Session Number:
23668
Tuition:
$60.00
Coordinator
Information
Coordinator Name:
Chris Johnson 
Coordinator Email:
chrismjohnson@fs.fed.us 
Coordinator Phone:
4065297751 
Coordinator Fax:
4062432047 
Nominee
Information
Nominee IQCS Emplid:
Optional. All Nominees in IQCS must provide their IQCS Emplid number. No number is required for those Nominees who are not in IQCS.
Nominee Name:
Required. First MiddleInitial Last
Nominee Title:
Optional. Nominee Job Title
Nominee Email:
Optional. Please provide a valid email address.
Training Officer Name:
Optional. Training Officer full name
Training Officer Email:
Optional. Training Officer email address
Training Officer Phone:
Optional. Training Officer phone number
Nominee Agency:
Required. Name of agency where Nominee is employed
Nominee Home Unit:
Required. Name of Nominee's Home Unit
Home Unit Street:
Required. Home Unit Address
Home Unit City:
Required. Home Unit City
Home Unit State:
Required. Home Unit State
Home Unit Zip Code:
Required. Home Unit Zip Code. If address is outside the USA, provide country information in Zip Code field.
Home Unit Phone:
Required. Home Unit Phone. Format 555-555-5555
Home Unit Fax:
Optional. Home Unit Fax. Format 555-555-5555
It is important that the Coordinator is able to contact the Nominee.
If Nominee cannot be contacted at Home Unit information above,
click "Nominee Alternative Address & Phone Information" link below and provide the information
Nominee
Training,
Qualifications &
Remarks
Nominee Training:
Required. List training and dates completed pertinent to this Course.
Nominee Qualifications:
Required. List your qualifications pertinent to this Course.
Remarks:
Optional. Add any other pertinent information.
Part II
PMS 921-2 (799)
NFES-2131
PART II - AGREEMENT TO COLLECT FUNDS (Complete only if there is a tuition charge)
There is a tuition charge of $60.00 for this Course Session. Please complete the applicable sections below.
Non-Federal
Agency
Information
Non-Federal Agency:
Contractor, states, governments engaged in fire suppression and protection of public lands. This training, payment and collection is duly authorized under the Intergovernmental Cooperation Act of 1968 as amended by the act of September 13, 1982 (P.L.97-258), Section 6505. The NWCG Interagency Training Nomination constitutes written request and it is understood the bill for the training will consist of tuition plus all other identifiable costs as provided by law. Authorizing signature is also certifying services requested cannot be procured reasonably and expeditiously through ordinary business channels and funds are available. Provider's signature certifies the agency is offering similar services for its own use.
Complete Charge Code:
Provide Charge Code. Include required fiscal references.
Agreement Number:
Other
Federal
Agency
Information
Other Federal Agency:
This training, payment, and collection is duly authorized under Section 601 of the Economy Act of June 30, 1932 (31 USC 1535) as amended. The NWCG Interagency Training Nomination constitutes the required written request and it is understood the bill for the training will consist of tuition plus all other identifiable costs as provided by law. Authorizing signatures is also certifying servies requested are in the best interest of the United States; cannot be procured by contract as conveniently or cheaply from a commercial source and appropriate funds are available for this purpose. Provider's signature certifies the agency is offering similar services for its own use.
Complete Charge Code:
Include agency location
Agreement Number:
Same
Agency
Information
Same Agency Provider:
The NWCG Interagency Training Nomination constitutes agreement to pay charges as outlined in nomination materials. Authorizing signature certifies funds are available for this purpose.
Complete Charge Code:
Provide Charge Code. Include Override.
Agreement Number:
Billing
Information
Billing Name:
Optional. Provide Billing Name and Address if different than Sponsor or Agency Name and Address.
Billing Address:
Billing City:
Billing State:
Billing Zip Code:
If address is outside the USA, provide country information in Zip Code field.
Sign &
Review
Nomination
Form
Security:
Type in the 4 numbers in the Security image. If you cannot read the Security image, click the image to refresh it.