National Wildland Fire Training

National Wildland Fire Training

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Nomination Form

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Course & Session Information	Course Code & Name: RX301 - Prescribed Fire Implementation Start & End Dates: 03-11-2019 to 03-15-2019 Location: Redmond, OR 97756 IQCS Session Number: 129 Tuition: $300.00
Coordinator Information	Coordinator Name: Mike Gomez Coordinator Email: mike.gomez@usda.gov Coordinator Phone: 541-504-7341 Coordinator Fax: 541-504-7345
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 Alternative Address & Phone Information Nominee Street: Optional. Address where Nominee can receive mail. Nominee City: Optional. City where Nominee can receive mail. Nominee State: Optional. State where Nominee can receive mail. Nominee Zip Code: Optional. Zip Code where Nominee can receive mail. If address is outside the USA, provide country information in Zip Code field. Nominee Phone: Optional. Phone where Nominee can be reached. Format 555-555-5555
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 $300.00 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.

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