Application for AMC Training Funds

Please submit no later than February 15. *Funds will only be made payable to the jurisdiction submitting the request.

Date: *

First Name: *

Last Name: *

Title:

Jurisdiction: *

Street Address: *

City: *

State: *

Zip Code: *

Phone Number: *

Fax Number:

Email Address: *

Amount Requested: *

Specifically explain what the training funds will be used for: *

Did you request funds last year?: *

YES

If you were approved last year, did you use your funds?:

YES

If no, explain.:

Has your jurisdiction participated in the Voluntary Quality Assurance Assessment?: *

YES

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