RT-219 Refresher Training for Helicopter Transport of External Cargo

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Nomination for RT-219 for January 18, 2020

Email *

Name *

Enter name as it should appear on course certificate. Example: John J Doe

Secondary Email address

Enter a secondary email address you will be able to access from November-January and during periods of leave.

Telephone *

Enter a telephone number (including area code) at which you can be contacted if there are questions regarding your nomination(s).

IQCS # *

Enter your IQCS Employee ID, or if you do not have an IQCS #, enter n/a.

Emergency Contact Information *

List Name and phone number of emergency contact

Supervisor's Name *

Supervisor's Email *

Supervisor's Phone Number *

Job Title

Enter your working job title

USFS Fire? *

If you are an employee of the USFS, indicate whether your position is a primary or secondary covered fire position (YES) or not a fire position (NO). If you are not a USFS employee, choose N/A.

YES

N/A

Sponsor *

Indicate the unit that certifies your qualifications (issues your qualification card). If you are an employee of any park in the Southeast Region, choose option 6. If you are an employee of any refuge in USFWS Region 4, choose option 7. Option 9 applies ONLY to employees of the Regional Office, not to all forests in the Southern Region.

Home Unit *

Enter your 5-6 character unit identifier (Examples: KY-KYCN, FL-EVP, GA-CHF, GA-R4R, VA-VAS).

The prerequisite for this class is listed below. Please check the box if it applies to you. *

Qualified as Helicopter Crewmember (HECM)

Required

This class is a 1 day class on Saturday January 18. Have you applied for other classes during this same time period? *

Yes

Required

If you applied for other classes during this same time period please list course title below.

Remarks

Please list any pertinent qualifications or justifications for acceptance to this class.

A copy of your responses will be emailed to the address you provided.

Submit

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