TN-KY WILDLAND FIRE TRAINING ACADEMY NOMINATION

Please e-mail completed nomination form to:  bonitajohnson@fs.fed.us
Course Number:  
S-212	Course Name:  
Wildland Fire Chainsaws	Priority _____ of ______	
IQCS Session Number: 
03375	Course Location:
TN-KY Wildland Fire Academy	Course Date(s):
01/8-12/2018	
Course Tuition (if required):
$300 (unless unit is a sponsor)
  see website for information	Course Coordinator:  
Tom Barnes	Course Coordinator Phone:
   423-569-2404 ext 284	
Date Submitted: 	Course Coordinator E-Mail:  

      Send all nominations to bonitajohnson@fs.fed.us	Course Coordinator  FAX:
   	
Employee’s IQCS ID Number:	
Nominee’s Name (First MI Last):	Agency:	
Working Job Title:	E-Mail (choose an address that will be valid Nov-Dec 2017):	
If USFS, is position primary/secondary fire (Yes or No): 	Fax: 	
Home Unit:	Nominee’s Mailing Address (valid in Nov-Dec 2017):	
Street:	Street:	
City:	State:	City:	State:	
Zip:	Telephone:	Zip:	Telephone:	
List training completed and dates pertinent to this course: please address prerequisite training requirements
	
List your past qualifications pertinent to this course: please address prerequisite experience requirements
	
Nominee’s Signature: (I will notify the Unit Training Representative if I am unable to attend.) 	
Supervisor’s Signature: (I certify the nominee meets the prerequisites, or, if not met, I will put the reasons for attending the course in Remarks.)	
Remarks: