Course Name Today's Date Anticipated # of Attendees Requested Training Dates: 1st Choice Requested Training Date: 2nd Choice County Emergency Manager Your Agency Name Point of Contact Name Point of Contact Phone Number Your Region - None -NorthwestNorth CentralNortheastSouthwestSouth CentralSoutheastSouthSan Luis ValleyWest Has the emergency manager been informed of request? - None -YesNo Has the regional homeland security coordinator been informed of request? - None -YesNo Needs Assessment Needs Assessment: Provide a brief statement of the needs assessment conducted in the region or jurisdictional area that identified the needs for the training. Gap Analysis Gap Analysis: What gaps have been identified to support this training request? Submit
