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Create Nomination Form for Intermediate ICS - AK_I300_02-22-2010_#1349

Part One

Before proceeding, click the yellow Help button in the right corner and read the Help Topic, 'Online Nomination Form - Overview'.

Course Session
Information
Course Code: I300    Course Name: Intermediate ICS
IQCS Session #:      Location: Wasilla, AK
Start Date: 2-22-2010    End Date: 2-24-2010
Tuition: $0.00
Coordinator
Information
Name: Johnny Murdock
Email: Johnny.Murdock@matsugov.us
Phone: 907-373-8807
Fax: 907-376-0799
Nominee
Information
All Nominees in IQCS must provide their IQCS Emplid number. No number is required for those Nominees who are not in IQCS.
REQUIRED. First Name - Middle Initial - Last Name
Provide a valid email address.
REQUIRED. Provide name of agency where Nominee is employed.
Home Unit
Information
REQUIRED.
REQUIRED.
REQUIRED.
REQUIRED.
REQUIRED.
REQUIRED. Format - 555-555-5555
Format - 555-555-5555
Nominee
Address
Provide Nominee address information only if different than Home Unit Address.
Format - 555-555-5555 Provide a phone number where Nominee can be reached.
Nominee
Training and
Qualifications
REQUIRED. List training and dates completed pertinent to this Course.
REQUIRED. List your past qualifications pertinent to this Course.
Add other pertinent information if any.
Part Two

There is NO tuition charge for this Course Session. You do NOT have to complete the section below.

PMS 921-2(799) NFES-2131 Nom form

PART II - AGREEMENT TO COLLECT FUNDS (Complete only if there is a tuition charge)

Course Name: Intermediate ICS    Tuition: $ .00

Non-Federal
Agency
Information

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.

Provide Charge Code. Include required fiscal references.
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.

Include agency location.
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.

Provide Charge Code. Include Override.
Billing
Information
Provide Billing Name and Address if different than Sponsor or Agency Name and Address.

PLEASE NOTE: The signature blocks will appear on the completed form.

Create Your
Nomination
Form
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