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 23-011 Aerial Apparatus Driver/ Operator; Dates: 5/2, 5/5, 5/8, 5/11, & 5/23; Location: Brunswick Volunteer Fire Company
    2. TB 23-015 Fire Officer III (Pilot); Dates: 9/19, 9/28, 10/4, 10/13, 10/19, & 10/25; Location Northgate Fire Station #29
    3. TB 23-016 Pumping Apparatus Driver - Operator; Dates: 9/6, 9/20, 9/27, 9/30, & 10/4; Location: PSTF
    4. TB 23-017 Excercising Leadership Through Difficult Conversations (NFA); Dates: 6/27 & 6/28; Location: PSTF
31. Course Information - MFRI North Central & Western MD Regions
33. Conducting Safe Live Fire Training Evolutions

    1. MGMT-215-S007-2023; Start Date 4/30/23; End Date: 5/7/23; Registration Close: 4/10/23; Location Washington County Public Safety Training Center
    2. MGMT-215-A008-2023; Start Date 5/24/2023; End Date 5/30/2023; Registration Close 5/4/2023; Location: Howard County DFRS Training Academy
35. Fire Inspector III

    1. MGMT-302-S005-2023; Start Date: 5/25/23; End Date 6/15/2023; Registration Close 5/5/23; Location: Howard County DFRS Training Academy
    2. N/A
37. Hazardous Materials Technician

    1. HM-201-S009-2023; Start Date: 6/3/23; End Date: 7/2/23; Registration Close: 5/14/23; Location: Shaft Volunteer Fire Company
    2. N/A
39. ICS-300: Intermediate ICS for Expanding Incidents (NFA)

    1. MGMT-263-S018-2023; Start Date: 5/13/23; End Date: 5/20/23; Registration Close: 4/24/23; Location: Myersville Volunteer Fire Company, Inc
    2. N/A
41. ICS-400: Advanced ICS for Complex Incidents (NFA)

    1. MGMT-264-S016-2023; Start Date: 6/10/23; End Date: 6/11/23; Registration Close: 5/21/23; Location: Myersville Volunteer Fire Company
    2. N/A
45. Other Courses (not listed above)
47. Course Title
48. Course Number
49. Course Location
51. Start Date
    Start Date
52. Complete Date
    Complete Date
53. Deadline to Register
    Deadline to Register
55. PLEASE ATTACH INFORMATION (BROCHURE, NOTICE, ETC.) ABOUT THE COURSE.
56. Attachments
58. REFER TO DFRS POLICY 2.01.11 FOR REGISTRATION INFORMATION.
60. Cost of Class/Course

    Check all that apply

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

    1. Air Fare
    2. Travel

    1. Per Diem
    2. Other
61. Itemized Cost
63. County Vehicle Request?

    1. Yes
    2. No
64. Pickup Date and Drop off Date
    Pickup Date and Drop off Date Start Date

    —

    Pickup Date and Drop off Date End Date
65. Estimate Vehicle Mileage
    (Estimate mileage) x (Current rate) = Travel Cost
67. Comments
71. Supervisors
73. 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. Grossnickle, Troy

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

    1. Poole, Kenneth
    2. Schultz, Steve
    3. Scott, Charles
    4. Stolberg, Lenne
    5. Wade, Jeremy
    6. Wallick, Doug
75. 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. Bare, Craig
    7. Bennett, Donnie
    8. Brown, Jared
    9. Burke, Edward
    10. Chlebowski, Josef
    11. Coe, David
    12. Coe, Jordan
    13. Creager, Kevin
    14. Davis, James
    15. Day, Alan
    16. Dimopoulos, Christopher
    17. Dickinson, Jason
    18. Dishart, Joshua
    19. Donovan, Sean
    20. Dunn, Christopher
    21. Elliott, Harry
    22. Fisher, James

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

    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. Pressman, Cameron
    17. Prestia, Christopher
    18. Reda, Mario
    19. Richman, Jeffrey
    20. Rossomondo, William
    21. Ruch, Glenn
    22. Russell, Troy

    1. Shaw, Matthew
    2. Shelton, Timothy
    3. Sherman, Tyler
    4. Springirth, Jesse
    5. Stansbury, Matthew
    6. Staub, Bradley
    7. Steele, Michael
    8. Steinberg, Adam
    9. Stitely, Richard
    10. Strausbaugh, Kyle
    11. Studds, Bernard
    12. Stull, Jeffrey
    13. Trevey, Kevin
    14. Tucker, Clarence
    15. Veith, William
    16. Walter, Joshua
    17. Weaver, Jeremy
    18. Webb, Michael
    19. Wilby, Matthew
    20. Wiles, Matthew
    21. Winters, Daniel
    22. Yingling, David
77. 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.
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85. 1. Receive an email copy of this form.
86. Email address

    This field is not part of the form submission.

87. Submit Submit and Print

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