EmailMe Form - Jackson County FD3 Training Request Form

District *

Request Type *

Name (first and last) *

First Last

Shift *

Name of Course *

Cost of registration for class *

Reason for the request *

Please describe the purpose of your request

Course Start Date *

MM / DD / YYYY

Course End Date *

MM / DD / YYYY

Is lodging required? *

Yes

No

Estimated Cost of Lodging *

Indicate if cost is per night or total

Is a District vehicle needed? *

Yes

No

Is airfare needed *

Yes

No

Estimated cost of airfare *

Special Travel Notes or Requests

Transportation needs or details for your travel and per diem

Time Off Requested *

Example: 6/24 from 0800 to 6/25 at 1700 -or- None if not during working hours

Any additional info you want to provide:

Please include any details regarding early registration discounts, membership discounts, or any other pertinent details needed for the request.

Attach the link to the class announcement or flyer for the class here.

Copy/paste the URL to your course here:

Immediate Supervisor Approval *

Yes

No

Have you discussed and received approval from your immediate supervisor for this request?