DFRS TRAINING REQUEST FORM

2. 
3. Training Request Form
   Required for all DFRS personnel
5. Employee Information
7. First Name*
8. Last Name*
10. Address1*
12. City*
13. State*
    -- Select One --MDPAWVVA
14. Zip*
16. Date of Birth*
    Date of Birth
17. Phone Number*
18. Email Address*
20. Station/Shift*
21. EMT Expiration Date
    EMT Expiration Date
22. CPR Expiration Date
    CPR Expiration Date
26. Course Information - DFRS Academy
28. Academy Courses

    1. Emergency Response to MARC Train Incidents; Location: PSTF & Brunswick Rail Yard; Date: Dec 3rd; Times: 0800-1500
    2. Executive Skills Series: Exercising Leadership Through Difficult Conversations; Location: PSTF; Dates: 1/3-1/4; Times 0800-1500
32. Course Information - MFRI North Central & Western MD Regions
34. Aerial Apparatus Driver/Operator

    1. FIRE-114-A022-2022 Start Date: 03-16-2022 End Date: 03-31-2022 Registration Close: 02-27-2022 Howard County DFRS Training Academy
    2. FIRE-114-S026-2022 Start Date: 06-01-2022 End Date: 06-18-2021 Registration Close: 05-12-2022 Frederick County Training Center
36. Building Construction for the Fire Service

    1. FIRE-125-S004-2022 Start Date: 01-31-2022 End Date: 02-12-2022 Registration Close: 01-11-2022 Carroll County Public Safety Training Center
38. Conducting Safe Live Fire Training Evolutions

    1. MGMT-215-A006-2022 Start Date: 01-18-2022 End Date: 01-27-2022 Registration Close: 12-29-2021 Howard County DFRS Training Academy
40. Decision-Making for Initial Company Operations (NFA)

    1. FIRE-137-A003-2022 Start Date: 04-08-2022 End Date: 04-14-2022 Registration Close: 03-19-2022 Howard County DFRS Training Academy
42. Emergency Medical Services Officer I (PILOT)

    1. MGMT-203-A006-2022 Start Date: 03-03-2022 End Date: 04-05-2022 Registration Close: 02-14-2022 Howard County DFRS Training Academy
44. Executive Skills Series: Exercising Leadership Through Difficult Conversations (NFA)

    1. MGMT-236-S001-2022 Start Date: 03-08-2022 End Date: 03-14-2022Registration Close: 02-19-2022 Howard County DFRS Training Academy
46. Executive Skills Series: Exercising Leadership to Facilitate Adaptive Change (NFA)

    1. MGMT-230-S001-2022 Start Date: 01-21-2022 End Date: 02-02-2022 Registration Close: 01-01-2022 Howard County DFRS Training Academy
48. Fire Department Health and Safety Officer

    1. MGMT-216-A005-2022 Start Date: 04-19-2022 End Date: 05-13-2022 Registration Close: 03-30-2022 Howard County DFRS Training Academy
    2. MGMT-216-S002-2022 Start Date: 01-26-2022 End Date: 02-16-2022 Registration Close: 01-06-2022 Frostburg Volunteer Fire Department
50. Fire Department Incident Safety Officer

    1. MGMT-217-S006-2022 Start Date: 11-30-2021 End Date: 12-16-2021 Registration Close: 11-10-2021 Howard County DFRS Training Academy
    2. MGMT-217-S007-2022 Start Date: 01-05-2022 End Date: 01-24-2022 Registration Close: 12-16-2021 Frederick County Training Center
    3. MGMT-217-S015-2022 Start Date: 04-05-2022 End Date: 04-28-2022 Registration Close: 03-16-2022 Carroll County Public Safety Training Center
    4. MGMT-217-A012-2022 Start Date: 06-13-2022 End Date: 06-22-2022 Registration Close: 05-24-2022 Howard County DFRS Training Academy
52. Fire Inspector I (PILOT)

    1. MGMT-204-A015-2022 Start Date: 04-12-2022 End Date: 04-27-2022 Registration Close: 03-23-2022 Howard County DFRS Training Academy
54. Fire Inspector II (PILOT)

    1. MGMT-205-S008-2022 Start Date: 05-20-2022 End Date: 06-10-2022 Registration Close: 04-30-2022 Howard County DFRS Training Academy
56. Fire Officer I (PILOT)

    1. MGMT-201-A022-2022 Start Date: 01-05-2022 End Date: 02-16-2022 Registration Close: 12-16-2021 Howard County DFRS Training Academy
    2. MGMT-201-S028-2022 Start Date: 01-31-2022 End Date: 04-11-2022 Registration Close: 01-11-2022 Frederick County Training Center
58. Fire Officer II

    1. MGMT-202-S007-2022 Start Date: 11-30-2021 End Date: 01-18-2022 Registration Close: 11-10-2021 Frederick County Training Center
    2. MGMT-202-S003-2022 Start Date: 04-04-2022 End Date: 05-23-2022 Registration Close: 04-15-2022 Washington County Division of Emergency Services Headquarters
60. Fire Officer II (PILOT)

    1. MGMT-202-S021-2022 Start Date: 01-11-2022 End Date: 02-10-2022 Registration Close: 12-22-2021 Carroll County Public Safety Training Center
    2. MGMT-202-S014-2022 Start Date: 03-01-2022 End Date: 03-31-2022 Registration Close: 02-12-2022 Howard County DFRS Training Academy
62. Fire Officer III (PILOT)

    1. MGMT-301-S011-2022 Start Date: 02-17-2022 End Date: 04-14-2022 Registration Close: 01-28-2022 Carroll County Public Safety Training Center
    2. MGMT-301-S008-2022 Start Date: 02-28-2022 End Date: 04-14-2022 Registration Close: 02-08-2022 Howard County DFRS Training Academy
    3. MGMT-301-S012-2022 Start Date: 04-18-2022 End Date: 06-13-2022 Registration Close: 03-29-2022 Frederick County Training Center
64. Fire Officer IV (PILOT)

    1. MGMT-401-S008-2022 Start Date: 04-26-2022 End Date: 06-01-2022 Registration Close: 04-06-2022 Howard County DFRS Training Academy
66. ICS-300: Intermediate ICS for Expanding Incidents (NFA)

    1. MGMT-263-S013-2022 Start Date: 05-06-2022 End Date: 05-12-2022 Registration Close: 04-17-2022 Howard County DFRS Training Academy
68. ICS-400: Advanced ICS for Complex Incidents (NFA)

    1. MGMT-264-S005-2022 Start Date: 12-04-2021 End Date: 12-05-2021 Registration Close: 11-15-2021 Frederick County Training Center
    2. MGMT-264-S012-2022 Start Date: 06-08-2022 End Date: 06-17-2022 Registration Close: 05-19-2022 Howard County DFRS Training Academy
70. Incident Safety Officer (NFA)

    1. MGMT-129-S002-2022 Start Date: 11-20-2021 End Date: 11-21-2021 Registration Close: 10-31-2021 Vigilant Hose Co Activities Bldg
72. Instructor I (PILOT)

    1. MGMT-110-S027-2022 Start Date: 04-18-2022 End Date: 05-18-2022 Registration Close: 03-29-2022 Carroll County Public Safety Training Center
    2. MGMT-110-A024-2022 Start Date: 05-16-2022 End Date: 06-06-2022 Registration Close: 04-27-2022 Howard County DFRS Training Academy
74. Instructor II/III (PILOT)

    1. MGMT-210-A014-2022 Start Date: 01-10-2022 End Date: 01-31-2022 Registration Close: 12-21-2021 Howard County DFRS Training Academy
76. Leadership in Supervision: Creating Environments for Professional Growth (NFA)

    1. MGMT-241-S002-2022 Start Date: 02-18-2022 End Date: 03-02-2022 Registration Close: 01-29-2022 Howard County DFRS Training Academy
78. Leadership in Supervision: Frameworks to Success (NFA)

    1. MGMT-243-S002-2022 Start Date: 01-06-2022 End Date: 01-12-2022 Registration Close: 12-17-2021 Howard County DFRS Training Academy
80. Leadership in Supervision: Perspectives in Thinking (NFA)

    1. MGMT-242-S002-2022 Start Date: 01-04-2022 End Date: 01-07-2022 Registration Close: 12-15-2021 Howard County DFRS Training Academy
82. Preparation for Initial Company Operations (NFA)

    1. FIRE-133-A004-2022 Start Date: 02-10-2022 End Date: 02-22-2022 Registration Close: 01-21-2022 Howard County DFRS Training Academy
84. Pumping Apparatus Driver/Operator

    1. FIRE-113-A026-2022 Start Date: 04-11-2022 End Date: 05-02-2022 Registration Close: 03-22-2022 Howard County DFRS Training Academy
    2. FIRE-113-S034-2022 Start Date: 04-11-2022 End Date: 05-25-2022 Registration Close: 03-22-2022 Frederick County Training Center
    3. FIRE-113-S033-2022 Start Date: 05-12-2022 End Date: 06-14-2022 Registration Close: 04-23-2022 Carroll County Public Safety Training Center
86. Strategy And Tactics For Initial Company Operations (NFA)

    1. FIRE-124-A006-2022 Start Date: 03-08-2022 End Date: 03-11-2022 Registration Close: 02-19-2022 Frederick County Training Center
    2. FIRE-124-A005-2022 Start Date: 05-05-2022 End Date: 05-17-2022 Registration Close: 04-16-2022 Howard County DFRS Training Academy
90. Other Courses (not listed above)
92. Course Title
93. Course Number
94. Course Location
96. Start Date
    Start Date
97. Complete Date
    Complete Date
98. Deadline to Register
    Deadline to Register
100. PLEASE ATTACH INFORMATION (BROCHURE, NOTICE, ETC.) ABOUT THE COURSE.
101. Attachments
103. REFER TO DFRS POLICY 2.01.11 FOR REGISTRATION INFORMATION.
105. Cost of Class/Course

     Check all that apply

     1. Hotel
     2. Tuition
     3. Books

     1. Air Fare
     2. Travel

     1. Per Diem
     2. Other
106. Itemized Cost
108. County Vehicle Request?

     1. Yes
     2. No
109. Pickup Date
     Pickup Date
110. Estimate Vehicle Mileage
     (Estimate mileage) x (Current rate) = Travel Cost
112. Comments
116. Supervisors
118. Chiefs*

     If applicable, in addition to your Battalion Chief, also select Battalion Chief Mike Cole for ALS Training. For Special Ops, also select Lenne Stolberg. IF REQUESTING A VEHICLE OR IF THERE IS A FEE ASSOCIATED WITH THIS TRAINING, ALSO SELECT THE BATTALION CHIEF OF TRAINING.

     1. Barnes, David
     2. Coe, Tom
     3. Cole, Mike
     4. Dmuchowski, Mike
     5. Grossnickle, Troy
     6. Hahn, Rusty

     1. Healy, Dan
     2. Leatherman, Steve
     3. Malta, Francis
     4. Morgan, James
     5. Morlan, Christopher
     6. Mullendore, Christopher

     1. Newman, Jon
     2. Poole, Kenneth
     3. Scott, Charles
     4. Stolberg, Lenne
     5. Wade, Jeremy
     6. Wallick, Doug
120. Captains & Lieutenants

     Captains & Lieutenants will receive immediate notification of training request.

     1. Ahalt, Bill
     2. Arnold, John
     3. Austin, Thomas
     4. Baer, Richie
     5. Bauer, Eric
     6. Bailey, Andre'
     7. Bare, Craig
     8. Bennett, Donnie
     9. Brown, Jared
     10. Burke, Edward
     11. Carmack, Newman
     12. Cave, Chad
     13. Chlebowski, Josef
     14. Coe, David
     15. Coe, Jordan
     16. Creager, Kevin
     17. Davis, James
     18. Day, Alan
     19. Dimopoulos, Christopher
     20. Dickinson, Jason
     21. Dishart, Joshua
     22. Donovan, Sean

     1. Dunn, Christopher
     2. Elliott, Harry
     3. Fisher, James
     4. Freeman, Robert
     5. Gordon, Scott
     6. Goforth, Kevin
     7. Green, Charlie
     8. Haddad, Jonathan
     9. Hardin, Daniel
     10. Hardin, Douglas
     11. Harne, Jacob
     12. Harner, Tyler
     13. Hayter, Daniel
     14. Hubble, Keith
     15. Hubler, David
     16. Hudson, Kenneth
     17. Jacobs, Eric
     18. Johnikin, Anne
     19. Jones, Stephen
     20. Karas, Matthew
     21. Kessler, Larry
     22. King, Patrick

     1. Komykoski, Jason
     2. Lal, David
     3. Lane, George
     4. Leonard, Michael
     5. Lewis, Steven
     6. Love, Vernon
     7. McCaa, Robert
     8. McKittrick, Jesse
     9. McTighe Jr., Patrick
     10. Miller, Matthew
     11. Moravec, Steven
     12. Nye, Matthew
     13. Osele, Michael
     14. Parr, Joel
     15. Peterson, Jeremy
     16. Richman, Jeffrey
     17. William Rossomondo
     18. Ruch, Glenn
     19. Schultz, Steve
     20. Schwab, Warren
     21. Shaw, Matthew
     22. Shelton, Timothy

     1. Sherman, Tyler
     2. Stansbury, Matthew
     3. Staub, Bradley
     4. Steele, Michael
     5. Steinberg, Adam
     6. Stitely, Richard
     7. Strausbaugh, Kyle
     8. Studds, Bernard
     9. Stull, Jeffrey
     10. Tucker, Clarence
     11. Veith, William
     12. Wachter, Vernon
     13. Walter, Joshua
     14. Weaver, Jeremy
     15. Webb, Michael
     16. Welsh, Larrie
     17. Wilby, Matthew
     18. Wiles, Matthew
     19. Winters, Daniel
     20. Yingling, David
     21. Yoder, Daniel
122. I agree to submit to DFRS documentation regarding my successful completion of this course. I further agree to abide by the Travel Regulations and Expense Report procedures detailed in Section IV of the Frederick County Purchasing Rules & Regulations, if applicable.*

     1. Checking box is equivalent to my electronic signature.
126. Approved As:

     1. Miscellaneous
     2. Compensated
     3. Sponsored
     4. Declined
     5. Canceled
128. Comments
Leave This Blank:


132. 1. Receive an email copy of this form.
133. Email address

     This field is not part of the form submission.

134. Submit Submit and Print

* indicates a required field