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2. Request by:*
3. Title:*
5. What is this request for (check all that apply)*

   1. Training
   2. Travel

   1. Department Representation
6. Mode of transportation*

   1. City Vehicle
   2. Air

   1. Personal Vehicle
   2. Other
8. Is this request to learn a new skill?*
   -- Select One --YesNo
10. Date(s) of Class/Training/Travel*
12. Purpose of Class/Training/Travel:*
14. Description of Class/Training/Travel:*
16. Location of Class/Training/Travel*
18. Sponsoring Agency*
    -- Select One --Rogers Fire DepartmentNWA Regional TrainingOther Fire DepartmentADEMNational Fire AcademyArkansas Fire AcademyOther
19. If Other Sponsoring Agency (explain)
21. Class/Training/Travel Information
    (e.g. class flyer, registration, etc)
22. Has your supervisor approved this?*
    -- Select One --YesNo
24. Expenses (Approximate - See SOP 111)
26. Registration *
27. Lodging*
28. Vehicle/Fuel*
30. Air / Taxi*
31. Meals*
    If you are staying more than 3 hours away figure $10 per meal. If you are staying more than 3 hours away figure your rate by federal per diem. (https://www.gsa.gov/travel/plan-book/per-diem-rates/fy2019-mie-breakdown)
32. Other Expenses*
34. Total Expenses*
36. First Name*
37. Last Name*
39. Shift*
40. Station*
41. Supervisor*
42. Date*
    Date
Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit

* indicates a required field