Form Center

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 --MDPAWVVADE
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
25. Course Information - DFRS Academy
27. Academy Courses

    1. TB 23-031 Hazardous Materials / WMD Incident Commander; MFRI Course Number: HM-203-A002-2024; Location: Frederick County PSTF; Times 0800-1600; Dates: 1/2/24, 1/9/24, 1/16/24, & 1/23/24
    2. TB 23-033 Tactical Worksheet & Mayday Management Workshop
    3. N/A
31. West Point Leadership Training

    1. West Point Leadership Training TB 23-032

    Reference TB 23-032

    Registration Deadline 11/27/2023

    Please submit your summary memo to the right

32. West Point Leadership Training

    File Upload

36. Other Courses (not listed above)
38. Course Title
39. Course Number
40. Course Location
42. Start Date
    Start Date
43. Complete Date
    Complete Date
44. Deadline to Register
    Deadline to Register
46. PLEASE ATTACH INFORMATION (BROCHURE, NOTICE, ETC.) ABOUT THE COURSE.
47. Attachments
49. REFER TO DFRS POLICY 2.01.11 FOR REGISTRATION INFORMATION.
51. Cost of Class/Course

    Check all that apply

    1. Hotel
    2. Tuition
    3. Books (Non-MFRI)

    1. Air Fare
    2. Travel

    1. Per Diem Reimbursement
    2. Other
52. Itemized Cost
54. County Vehicle Request?

    1. Yes
    2. No
55. Pickup Date & Time and Drop off Date & Time
    Pickup Date & Time and Drop off Date & Time Start Date

    Pickup Date & Time and Drop off Date & Time Start Time

    —

    Pickup Date & Time and Drop off Date & Time End Date

    Pickup Date & Time and Drop off Date & Time End Time
56. Estimate Vehicle Mileage
    (Estimate mileage) x (Current rate) = Travel Cost
58. Comments
62. Supervisors
64. 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. Bailey, Andre
    3. Cave, Chad
    4. Coe, Tom
    5. Cole, Mike
    6. Dmuchowski, Mike
    7. Fisher, James

    1. Grossnickle, Troy
    2. Hahn, Rusty
    3. Healy, Dan
    4. Leatherman, Steve
    5. Malta, Francis
    6. Mullendore, Christopher

    1. Newman, Jon
    2. Poole, Kenneth
    3. Schultz, Steve
    4. Scott, Charles
    5. Stolberg, Lenne
    6. Wallick, Doug
66. Captains & Lieutenants

    Captains & Lieutenants will receive immediate notification of training request.

    1. Ahalt, Bill
    2. Arnold, John
    3. Austin, Thomas
    4. Bauer, Eric
    5. Bare, Craig
    6. Bennett, Donnie
    7. Brown, Jared
    8. Burke, Edward
    9. Chlebowski, Josef
    10. Coe, David
    11. Coe, Jordan
    12. Creager, Kevin
    13. Davis, James
    14. Day, Alan
    15. Dimopoulos, Christopher
    16. Dickinson, Jason
    17. Dishart, Joshua
    18. Donovan, Sean
    19. Dunn, Christopher
    20. Freeman, Robert
    21. Freyman, Bret

    1. Gordon, Scott
    2. Goforth, Kevin
    3. Haddad, Jonathan
    4. Hardin, Daniel
    5. Harne, Jacob
    6. Harner, Tyler
    7. Hayter, Daniel
    8. Hubble, Keith
    9. Hubler, David
    10. Hudson, Kenneth
    11. Huntington, Jason
    12. Johnikin, Anne
    13. Johnson, Matthew
    14. Jones, Stephen
    15. Karas, Matthew
    16. Kessler, Larry
    17. King, Patrick
    18. Knight, Matthew
    19. Knight, Michael
    20. Komykoski, Jason
    21. Lal, David

    1. Lane, George
    2. Leonard, Michael
    3. Lewis, Steven
    4. Love, Vernon
    5. McCaa, Robert
    6. McKittrick, Jesse
    7. McTighe Jr., Patrick
    8. Miller, Matthew
    9. Moravec, Steven
    10. Nye, Matthew
    11. Osele, Michael
    12. Parr, Joel
    13. Pressman, Cameron
    14. Prestia, Christopher
    15. Reda, Mario
    16. Richman, Jeffrey
    17. Rossomondo, William
    18. Ruch, Glenn
    19. Russell, Troy
    20. Shaw, Matthew
    21. Shelton, Timothy

    1. Sherman, Tyler
    2. Springirth, Jesse
    3. Stansbury, Matthew
    4. Staub, Bradley
    5. Steele, Michael
    6. Steinberg, Adam
    7. Stitely, Richard
    8. Strausbaugh, Kyle
    9. Studds, Bernard
    10. Stull, Jeffrey
    11. Trevey, Kevin
    12. Tucker, Clarence
    13. Veith, William
    14. Walter, Joshua
    15. Weaver, Jeremy
    16. Webb, Michael
    17. Wilby, Matthew
    18. Wiles, Matthew
    19. Winters, Daniel
    20. Yingling, David
68. 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.
Leave This Blank:


76. 1. Receive an email copy of this form.
77. Email address

    This field is not part of the form submission.

78. Submit Submit and Print

* indicates a required field