Forms • Flagstaff • CivicEngage

Today's Date*

Course Title *

Conducted by FPD*

Location (City & State) *

Dates of Course and time of course *

Requesting Officer Name*

Rank and Years of Service *

Please describe any previous classes in this area or explanation of interest in this course

Is there a Host Hotel? *

Yes

NO

Estimated Date and Time Leaving *

Estimated Date/Time Returning *

Registration Fee *

Web Link and or Contact Information for registration

Transportation by N/A

	Rental Car
	Private Car
	City Vehicle

	Scheduled Airline
	Other

Expenses to be advanced (mark all that apply)

	Per Diem
	Lodging
	Gasoline

	Airfare
	Registration
	Other

Will this travel be submitted for reimbursement from an outside agency (Ex. GOHS, AZ Post, etc)? *

Yes

NO

If Yes: Contact information for whom to submit reimbursement to:
What will be reimbursed and at what rate (if you were able to obtain this from your contact?
Per Diem, Lodging, Gasoline, Airline, Registration, Other reimbursements. Please specify.

* indicates required fields.

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