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. Pumping Apparatus Driver / Operator; Location: PSTF; Dates: 7/26, 8/2, 8/9, 8/16, 8/23, 8/30, 9/6; Times 0800-1600
29. Strength & Conditioning Training

    Kayla will be offering strength training sessions for all members who are interested in improving their overall fitness, regardless of your current level. These sessions are designed to help you build strength, endurance, mobility, and work capacity so that you can perform at your highest level. All fitness levels are welcome, and workouts will be tailored to your individual ability.  They will be fun, job related, tough, but not impossible to complete. 

    Please see TB 22-013 for Sign Up Genius Registration link.

    1. Strength & Conditioning Training
33. Course Information - MFRI North Central & Western MD Regions
37. Other Courses (not listed above)
39. Course Title
40. Course Number
41. Course Location
43. Start Date
    Start Date
44. Complete Date
    Complete Date
45. Deadline to Register
    Deadline to Register
47. PLEASE ATTACH INFORMATION (BROCHURE, NOTICE, ETC.) ABOUT THE COURSE.
48. Attachments
50. REFER TO DFRS POLICY 2.01.11 FOR REGISTRATION INFORMATION.
52. Cost of Class/Course

    Check all that apply

    1. Hotel
    2. Tuition
    3. Books

    1. Air Fare
    2. Travel

    1. Per Diem
    2. Other
53. Itemized Cost
55. County Vehicle Request?

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

    —

    Pickup Date and Drop off Date End Date
57. Estimate Vehicle Mileage
    (Estimate mileage) x (Current rate) = Travel Cost
59. Comments
63. Supervisors
65. 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. Cave, Chad
    3. Coe, Tom
    4. Cole, Mike
    5. Dmuchowski, Mike
    6. Grossnickle, Troy

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

    1. Newman, Jon
    2. Poole, Kenneth
    3. Scott, Charles
    4. Stolberg, Lenne
    5. Wade, Jeremy
    6. Wallick, Doug
67. 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. Chlebowski, Josef
    12. Coe, David
    13. Coe, Jordan
    14. Creager, Kevin
    15. Davis, James
    16. Day, Alan
    17. Dimopoulos, Christopher
    18. Dickinson, Jason
    19. Dishart, Joshua
    20. Donovan, Sean
    21. Dunn, Christopher
    22. Elliott, Harry

    1. Fisher, James
    2. Freeman, Robert
    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. Jones, Stephen
    17. Karas, Matthew
    18. Kessler, Larry
    19. King, Patrick
    20. Knight, Matthew
    21. Knight, Michael
    22. Komykoski, Jason

    1. Lal, David
    2. Lane, George
    3. Leonard, Michael
    4. Lewis, Steven
    5. Love, Vernon
    6. McCaa, Robert
    7. McKittrick, Jesse
    8. McTighe Jr., Patrick
    9. Miller, Matthew
    10. Moravec, Steven
    11. Nye, Matthew
    12. Osele, Michael
    13. Parr, Joel
    14. Peterson, Jeremy
    15. Richman, Jeffrey
    16. Rossomondo, William
    17. Ruch, Glenn
    18. Russell, Troy
    19. Schultz, Steve
    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. Welsh, Larrie
    18. Wilby, Matthew
    19. Wiles, Matthew
    20. Winters, Daniel
    21. Yingling, David
69. 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.
73. Approved As:

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


79. 1. Receive an email copy of this form.
80. Email address

    This field is not part of the form submission.

81. Submit Submit and Print

* indicates a required field