AGREEMENT TO COLLECT FUNDSNWCG Interagency Training Nomination and Agreement to Collect Funds • September 14th, 2004
Contract Type FiledSeptember 14th, 2004Course Number Course Name PRIORITY of IQCS Session Number Course Location Course Date(s) Course Tuition (if required) Course Coordinator Name (First Last) Course Coordinator Phone Number Course Coordinator E-Mail Course Coordinator FAX Number Date Submitted Employee’s IQCS ID Number: Nominee’s Name (First MI Last) Working Job Title E-Mail Agency Name Fax Home Unit Nominee’s Mailing Address (if different) Street Street City State City State Zip Telephone Zip Telephone List training completed and dates pertinent to this course: List your past qualifications pertinent to this course: Nominee’s Signature: (I will notify the Unit Training Representative if I am unable to attend.) Supervisor’s Signature (I certify the nominee meets the prerequisites, or if not met I will put the reasons for attending the course in Remarks.) Remarks: