Create Nomination Form for Incident Training Specialist - GB_S445_12-02-2008_#300

Training Officers: This session uses the IQCS Nomination Workflow process.

Part One	Steps to create a Nomination Form for you to give to your training officer Please note! The pre-filled Nomination Form does not submit your Nomination. The form can be used to communicate your information to your Training Officer. Complete the form below. Fill in all required fields, including the "Security Code" at the bottom. Click the "Save Form" button, accept the confirmation to digitally sign your form and to proceed to the "Review Your Nomination Form" page. (Optional) On the Review page, if necessary, click the "Edit" button to go back to the form and make corrections. When your form is correct and complete, on the Review page, you have several choices: Click the "Generate RTF" button to save your form in a format that will allow you to EDIT, email and/or print, etc. SAVE the RTF to your computer, and then open your nomination_form.rtf with word processor software, such as Microsoft Word. Click the "Generate PDF" button to save your form in a format to email and/or print. SAVE the resulting PDF to your computer. You may VIEW your nomination_form.pdf with free Adobe Reader. Note: PDFs cannot be edited without special PDF editing software. Click the "Print View" button to display a "printer friendly" view of the form. Note: this view cannot be saved.
Course Session Information	Course Code: S445 Course Name: Incident Training Specialist IQCS Session #: 17 Location: Boise, ID Start Date: 12-2-2008 End Date: 12-4-2008 Tuition: $250.00
Coordinator Information	Name: Ernie Ortiz Email: ernie_ortiz@nifc.blm.gov Phone: 208-387-5064 Fax: 208-387-5556
Nominee Information	Nominee IQCS Emplid: 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 Name - Middle Initial - Last Name Nominee Job Title: Nominee Email: Provide a valid email address. Nominee Agency Name: REQUIRED. Provide name of agency where Nominee is employed.
Home Unit Information	Nominee Home Unit: REQUIRED. Home Unit Address: REQUIRED. Home Unit City: REQUIRED. Home Unit State: REQUIRED. Home Unit Zipcode: REQUIRED. Home Unit Phone: REQUIRED. Format - 555-555-5555 Home Unit Fax: Format - 555-555-5555
Nominee Address	Nominee Address: Provide Nominee address information only if different than Home Unit Address. Nominee City: Nominee State: Nominee Zipcode: Nominee Phone: Format - 555-555-5555 Provide a phone number where Nominee can be reached.
Nominee Training and Qualifications	Nominee Training: REQUIRED. List training and dates completed pertinent to this Course. Nominee Qualifications: REQUIRED. List your past qualifications pertinent to this Course. Remarks: Add other pertinent information if any.
Part Two	There is a tuition charge for this Course Session. You MUST complete one of the sections below or your Nomination Form will not be accepted. Please check the section appropriate to the legal authority to collect monies and complete the billing address block. When completed, this form must be signed by an individual with authority to sign agreements and obligate the funds listed. Note: Tribal governments are not covered by the Intergovernmental Cooperation Act of 1968.
PMS 921-2(799) NFES-2131 Nom form	PART II - AGREEMENT TO COLLECT FUNDS (Complete only if there is a tuition charge) Course Name: Incident Training Specialist Tuition: $250.00
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	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 Provider	Same Agency as 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: Provide Billing Name and Address if different than Sponsor or Agency Name and Address. Billing Address: Billing City: Billing State: Billing Zipcode: PLEASE NOTE: The signature blocks will appear on the completed form.
Create Your Nomination Form	Security Code: Please type in the characters you see in the picture below