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2. Last Name
3. Request Date*
   Request Date
5. Date & Time*
   Date & Time Start Date

   Date & Time Start Time

   —

   Date & Time End Date

   Date & Time End Time
7. Total Training Time Requested in Hours*
8. Course Name*
9. Course Location*
11. Cost of Course (enter 0 if free)*
12. TCOLE Course #
13. Will a fleet vehicle or mileage reimbursement be needed?*

    1. Fleet vehicle
    2. Mileage reimbursement
14. Will lodging be needed?*

    1. Yes
    2. No
16. Shift Coverage*

    1. Yes
    2. No
17. If Mileage Reimbursement is needed, please list your home address and the training location's address.
    Example of correct answer: HOME= 123 SMART AVE., FT WORTH 76212 TRAINING= 78911 EDUCATION AVE, DECATUR, 70202
19. Comments:
21. Electronic Signature*
Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

* indicates a required field