Please read instructions on the last page before completing this form.

<table style="width:100%;">
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<col style="width: 4%" />
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<col style="width: 1%" />
<col style="width: 2%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 6%" />
<col style="width: 3%" />
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<col style="width: 4%" />
<col style="width: 3%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="13" rowspan="4"><p><strong>REQUEST, AUTHORIZATION,
AGREEMENT</strong></p>
<p><strong>AND CERTIFICATION OF TRAINING</strong></p></td>
<td colspan="8" rowspan="2"><p>A. Agency, code agency subelement</p>
<p>and submitting office number</p>
<p><em>(Example - - xx-xx-xxxx)</em></p></td>
<td colspan="2">01</td>
<td colspan="13" rowspan="2"><h2 id="b.-office-use-only">B. OFFICE USE
ONLY</h2></td>
</tr>
<tr class="even">
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="10" rowspan="2">     </td>
<td colspan="12">C. Request status <em>(Mark (X) one)</em></td>
<td>02</td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="4"><p>Initial or</p>
<p>Resubmission</p></td>
<td colspan="2"></td>
<td colspan="4">Correction or Cancellation</td>
<td></td>
</tr>
<tr class="odd">
<td colspan="36"><h3 id="section-a-----trainee-information">Section A -
- TRAINEE INFORMATION</h3></td>
</tr>
<tr class="even">
<td colspan="10">1. Applicant’s name <em>(Last-First-Middle
Initial)</em></td>
<td colspan="2" rowspan="2"><p>Enter first</p>
<p>5 letters of</p>
<p>last name</p></td>
<td>03</td>
<td colspan="8">2. Social Security Number</td>
<td colspan="2">04</td>
<td colspan="12">3. Date of birth <em>(Year and month)</em></td>
<td>05</td>
</tr>
<tr class="odd">
<td colspan="10"></td>
<td></td>
<td colspan="10"></td>
<td colspan="13"></td>
</tr>
<tr class="even">
<td colspan="10">     </td>
<td colspan="3">     </td>
<td colspan="10">     </td>
<td colspan="10">     </td>
<td colspan="3"><p><em>(Example-born</em></p>
<p><em>January 14, 1943</em></p>
<p><em>Shown as 43/01)</em></p></td>
</tr>
<tr class="odd">
<td colspan="13">2. Home address <em>(Number, Street, City, State, Zip
code)</em></td>
<td colspan="10">5. Home telephone</td>
<td colspan="13">6. Position level <em>(Mark (X) one only)</em></td>
</tr>
<tr class="even">
<td colspan="13" rowspan="2">     </td>
<td colspan="4" rowspan="2"><p>Area Code</p>
<p>     </p></td>
<td colspan="6" rowspan="2"><p>Number</p>
<p>     </p></td>
<td colspan="7"> a. Non-supervisory</td>
<td colspan="6"> c. Manager</td>
</tr>
<tr class="odd">
<td colspan="7"> b. Supervisory</td>
<td colspan="6"> d. Executive</td>
</tr>
<tr class="even">
<td colspan="13" rowspan="3"><p>7. Organization mailing address
<em>(Branch-Division/Office/Bureau/Agency)</em></p>
<p>     </p></td>
<td colspan="10">8. Office telephone</td>
<td colspan="7"><p>9. Continuous</p>
<p>civilian service</p></td>
<td colspan="6"><p>10. Number of prior</p>
<p>non-government</p></td>
</tr>
<tr class="odd">
<td colspan="4">Area Code</td>
<td colspan="3">Number</td>
<td colspan="3">Extension</td>
<td colspan="4">Years</td>
<td colspan="3">Months</td>
<td colspan="6">training days</td>
</tr>
<tr class="even">
<td colspan="4">     </td>
<td colspan="3">     </td>
<td colspan="3">     </td>
<td colspan="4">     </td>
<td colspan="3">     </td>
<td colspan="6">     </td>
</tr>
<tr class="odd">
<td colspan="7"><p>11a. Position title/function</p>
<p>     </p></td>
<td colspan="5"><p>11b. Applicant handi-</p>
<p>capped or disabled</p>
<p><em>(See instructions)</em></p></td>
<td></td>
<td colspan="10"><p>12. Pay Plan/series/grade/step</p>
<p>     </p></td>
<td colspan="7"><p>13. Type of appointment</p>
<p>     </p></td>
<td colspan="6"><p>14. Education level</p>
<p>     </p></td>
</tr>
<tr class="even">
<td colspan="36"><strong>Section B - - TRAINING COURSE
DATA</strong></td>
</tr>
<tr class="odd">
<td colspan="14"><p>15A. Name and mailing address of training vendor
<em>(No., Street, City, State, ZIP Code)</em></p>
<p>     </p></td>
<td colspan="22"><p>15b. Location of training site <em>(If same, mark
box)</em> -----------------► </p>
<p>     </p></td>
</tr>
<tr class="even">
<td colspan="36"><p>16. Course title and training objectives
<em>(Benefits to be derived by the Government)</em></p>
<p>     </p></td>
</tr>
<tr class="odd">
<td colspan="2">17. Catalog/Course No.</td>
<td colspan="7">18. Training period <em>(6 digits)</em></td>
<td colspan="2">06</td>
<td colspan="7">19. No. of course hours <em>(4 digits)</em></td>
<td>07</td>
<td colspan="17">20. Training codes <em>(See instructions)</em></td>
</tr>
<tr class="even">
<td colspan="2" rowspan="3">     </td>
<td colspan="2"></td>
<td>Year</td>
<td colspan="3">Month</td>
<td colspan="3">Day</td>
<td colspan="5">a. During duty</td>
<td colspan="3">    </td>
<td colspan="3"></td>
<td colspan="2">Code</td>
<td colspan="10"></td>
<td>Code</td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2">a. Start</td>
<td>  </td>
<td colspan="3">  </td>
<td colspan="3">  </td>
<td colspan="5">b. Non-duty</td>
<td colspan="3">    </td>
<td colspan="3">a. Purpose</td>
<td colspan="2">    </td>
<td colspan="10">08 c. Source</td>
<td>   </td>
<td>10</td>
</tr>
<tr class="even">
<td colspan="2">b. Complete</td>
<td>  </td>
<td colspan="3">  </td>
<td colspan="3">  </td>
<td colspan="5">c. TOTAL ►</td>
<td colspan="3">    </td>
<td colspan="3">b. Type</td>
<td colspan="2">    </td>
<td colspan="10">09 d. Special Interest</td>
<td>    </td>
<td>11</td>
</tr>
<tr class="odd">
<td colspan="36"><h2 id="agency-use-only">AGENCY USE ONLY</h2></td>
</tr>
<tr class="even">
<td colspan="15"><strong>Section C -- ESTIMATED COSTS AND BILLING
INFORMATION</strong></td>
<td colspan="21"><strong>Section D -- APPROVALS</strong></td>
</tr>
<tr class="odd">
<td colspan="15">21. Direct costs and appropriation/fund chargeable</td>
<td colspan="11">26a. Immediate supervisor – <em>Name and
title</em></td>
<td colspan="10">Area code/Tel. No./Extension</td>
</tr>
<tr class="even">
<td colspan="3" rowspan="2">Item</td>
<td colspan="3">Amount</td>
<td colspan="9" rowspan="2">Appropriation/fund</td>
<td colspan="11" rowspan="2">     </td>
<td colspan="10" rowspan="2">     </td>
</tr>
<tr class="odd">
<td colspan="3">Dollars Cents</td>
</tr>
<tr class="even">
<td colspan="3">a. Tuition</td>
<td colspan="3">     </td>
<td colspan="9" rowspan="5">     </td>
<td colspan="13" rowspan="2">b. Signature</td>
<td colspan="8" rowspan="2">Date</td>
</tr>
<tr class="odd">
<td colspan="3">b. Books or materials</td>
<td colspan="3">     </td>
</tr>
<tr class="even">
<td colspan="3">c. Other <em>(Specify)</em></td>
<td colspan="3">     </td>
<td colspan="11" rowspan="2"><p>27a. Second-line supervisor – <em>Name
and title</em></p>
<p>     </p></td>
<td colspan="10" rowspan="2"><p>Area code/Tel. No./Extension</p>
<p>     </p></td>
</tr>
<tr class="odd">
<td>d. (Enter 4 digits in</td>
<td colspan="2">12</td>
<td colspan="3" rowspan="2">     </td>
</tr>
<tr class="even">
<td colspan="3"><p>dollar column)</p>
<p>TOTAL ►</p></td>
<td colspan="13" rowspan="2">b. Signature</td>
<td colspan="8" rowspan="2">Date</td>
</tr>
<tr class="odd">
<td colspan="15">22. Indirect costs and appropriation/fund
chargeable</td>
</tr>
<tr class="even">
<td colspan="3" rowspan="2">Item</td>
<td colspan="3">Amount</td>
<td colspan="9" rowspan="2">Appropriation/fund</td>
<td colspan="11" rowspan="3"><p>28a. Training Officer – <em>Name and
title</em></p>
<p>     </p></td>
<td colspan="10" rowspan="3"><p>Area code/Tel. No./Extension</p>
<p>     </p></td>
</tr>
<tr class="odd">
<td colspan="3">Dollars Cents</td>
</tr>
<tr class="even">
<td colspan="3">a. Travel</td>
<td colspan="3">     </td>
<td colspan="9" rowspan="6">     </td>
</tr>
<tr class="odd">
<td colspan="3">b. Per Diem</td>
<td colspan="3">     </td>
<td colspan="13" rowspan="2">b. Signature</td>
<td colspan="8" rowspan="2">Date</td>
</tr>
<tr class="even">
<td colspan="3" rowspan="2">c. Other (Specify)</td>
<td colspan="3" rowspan="2">     </td>
</tr>
<tr class="odd">
<td colspan="21"><h1 id="section-e-approvalconcurrence">Section E –
APPROVAL/CONCURRENCE</h1></td>
</tr>
<tr class="even">
<td>d. (Enter 4 digits in</td>
<td colspan="2">13</td>
<td colspan="3" rowspan="2">     </td>
<td colspan="11" rowspan="3"><p>29a. Authorizing Officer – <em>Name and
title</em></p>
<p>     </p></td>
<td colspan="10" rowspan="3"><p>Area code/Tel. No./Extension</p>
<p>     </p></td>
</tr>
<tr class="odd">
<td colspan="3"><p>dollar column)</p>
<p>TOTAL ►</p></td>
</tr>
<tr class="even">
<td colspan="15" rowspan="2"><p>23. Document/Purchase Order/Requisition
No.</p>
<p>     </p></td>
</tr>
<tr class="odd">
<td colspan="11" rowspan="2">b. Signature</td>
<td colspan="6" rowspan="2"><p> Approved</p>
<p> Disapproved</p></td>
<td colspan="4" rowspan="2">Date</td>
</tr>
<tr class="even">
<td colspan="4" rowspan="3"><p>24. 8-Digit station symbol</p>
<p>(Example –12-34-5678) ---------►</p></td>
<td colspan="11" rowspan="3">     </td>
</tr>
<tr class="odd">
<td colspan="21"><h2
id="section-f-certification-of-training-completion">Section F –
CERTIFICATION OF TRAINING COMPLETION</h2></td>
</tr>
<tr class="even">
<td colspan="11" rowspan="2"><p>30a. Certifying Official – <em>Name and
title</em></p>
<p>     </p></td>
<td colspan="10" rowspan="2"><p>Area code/Tel. No./Extension</p>
<p>     </p></td>
</tr>
<tr class="odd">
<td colspan="15" rowspan="2"><p>25. BILLING INSTRUCTION <em>(Furnish
invoice to):</em></p>
<p>     </p></td>
</tr>
<tr class="even">
<td colspan="13">b. Signature</td>
<td colspan="8">Date</td>
</tr>
<tr class="odd">
<td colspan="36"><strong>TRAINING FACILITY ► Bills should be sent to
office indicated in item 25. • Please refer to number given in item 23
to assure prompt payment.</strong></td>
</tr>
</tbody>
</table>

**Copy 1 -- AGENCY (TRAINING/PERSONNEL FOLDER)** 182-106 Standard Form
182 (Rev. 12/79) (10-Part)

+--------------------------------------------------+-------------------+
| **NOTE:** This agreement must be signed by the   |                   |
| nominee for all **non-government** training that |                   |
| exceeds 80 hours (or such other designated       |                   |
| period, 80 hours or less, as prescribed by the   |                   |
| agency) and for which the Government approves    |                   |
| payment of training costs prior to the           |                   |
| commencement of such training. Nothing contained |                   |
| in Section G below shall be construed as         |                   |
| limiting the authority of an agency to waive,    |                   |
| **in whole or in part**, an obligation of an     |                   |
| employee to pay expenses incurred by the         |                   |
| Government in connection with the training.      |                   |
+--------------------------------------------------+-------------------+
| #### Section                                     |                   |
| G -- EMPLOYEE'S AGREEMENT TO CONTINUE IN SERVICE |                   |
|                                                  |                   |
| 1.  I AGREE that, upon completion of the         |                   |
|     Government-sponsored training described in   |                   |
|     this request, if I receive salary covering   |                   |
|     the training period, I will serve in the     |                   |
|     agency three times the length of the         |                   |
|     training period. If I receive no salary      |                   |
|     during the training period, I agree to serve |                   |
|     the agency for a period equal to the length  |                   |
|     of training, but in no case less than one    |                   |
|     month. (The length of part-time training is  |                   |
|     the number of hours spent in class or with   |                   |
|     the instructor. The length of full-time      |                   |
|     training is eight hours for each day of      |                   |
|     training, up to a maximum of 40 hours a      |                   |
|     week). NOTE: For the purposes of this        |                   |
|     agreement, the term "agency" refers to the   |                   |
|     employing organization (such as an Executive |                   |
|     Department or independent establishment),    |                   |
|     not to a segment of such an organization.    |                   |
|                                                  |                   |
| 2.  If I voluntarily leave the agency before     |                   |
|     completing the period of service agreed to   |                   |
|     in item 1 above, I AGREE to reimburse the    |                   |
|     agency for the tuition and related fees,     |                   |
|     travel and other special expenses (EXCLUDING |                   |
|     SALARY) paid in connection with my training. |                   |
|     These amounts are reflected in items 21 and  |                   |
|     22.                                          |                   |
|                                                  |                   |
| 3.  I FURTHER AGREE that, if I voluntarily leave |                   |
|     the agency to enter the service of another   |                   |
|     Federal agency or other organization in any  |                   |
|     branch of the Government before completing   |                   |
|     the period of service agreed to in item 1    |                   |
|     above, I will give my organization written   |                   |
|     notice of at least ten work days, during     |                   |
|     which time a determination concerning        |                   |
|     reimbursement will be made. If I fail to     |                   |
|     give this advance notice, I AGREE to pay the |                   |
|     amount of additional expenses (5 U.S.C.      |                   |
|     4109(a)(2)) incurred by the Government in    |                   |
|     this training.                               |                   |
|                                                  |                   |
| 4.  I understand that any amounts which may be   |                   |
|     due the agency as a result of any failure on |                   |
|     my part to meet the terms of this agreement  |                   |
|     may be withheld from any monies owed me by   |                   |
|     the Government, or may be recovered by such  |                   |
|     other methods as are approved by law.        |                   |
|                                                  |                   |
| 5.  I FURTHER AGREE to obtain approval from my   |                   |
|     organization training officer and that       |                   |
|     person responsible for authorizing           |                   |
|     non-government training requests of any      |                   |
|     proposed change in my approved training      |                   |
|     program involving course and schedule        |                   |
|     changes, withdrawals or incompletions, and   |                   |
|     increased costs.                             |                   |
|                                                  |                   |
| 6.  I acknowledge that this agreement does not   |                   |
|     in any way commit the Government to continue |                   |
|     my employment. I understand that, if there   |                   |
|     is a transfer of my service obligation to    |                   |
|     another Federal agency or other organization |                   |
|     in any branch of the Government, the         |                   |
|     agreements in items 1, 2, and 3 of this      |                   |
|     section will remain in effect until I have   |                   |
|     completed my obligated service with that     |                   |
|     other agency or organization.                |                   |
+--------------------------------------------------+-------------------+
| 31\. Period of obligated service                 |                   |
|                                                  |                   |
| (For non-government training only)               |                   |
| \-\-\-\-\-\-\-\-\-\-\-\-\-\-\-                   |                   |
| \-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\- |                   |
| \-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\- |                   |
| \-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\- |                   |
| \-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\--► |                   |
+--------------------------------------------------+-------------------+
| 32\. Employee's signature                        | Date              |
+--------------------------------------------------+-------------------+

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<col style="width: 3%" />
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<col style="width: 1%" />
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<col style="width: 3%" />
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<col style="width: 0%" />
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<col style="width: 1%" />
<col style="width: 0%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 4%" />
<col style="width: 3%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="13" rowspan="4"><p><strong>REQUEST, AUTHORIZATION,
AGREEMENT</strong></p>
<p><strong>AND CERTIFICATION OF TRAINING</strong></p></td>
<td colspan="8" rowspan="2"><p>A. Agency, code agency subelement</p>
<p>and submitting office number</p>
<p><em>(Example - - xx-xx-xxxx)</em></p></td>
<td colspan="2">01</td>
<td colspan="13" rowspan="2"><h2 id="b.-office-use-only-1">B. OFFICE USE
ONLY</h2></td>
</tr>
<tr class="even">
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="10" rowspan="2">     </td>
<td colspan="12">C. Request status <em>(Mark (X) one)</em></td>
<td>02</td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="4"><p>Initial or</p>
<p>Resubmission</p></td>
<td colspan="2"></td>
<td colspan="4">Correction or Cancellation</td>
<td></td>
</tr>
<tr class="odd">
<td colspan="36"><h3 id="section-a-----trainee-information-1">Section A
- - TRAINEE INFORMATION</h3></td>
</tr>
<tr class="even">
<td colspan="10">1. Applicant’s name <em>(Last-First-Middle
Initial)</em></td>
<td colspan="2" rowspan="2"><p>Enter first</p>
<p>5 letters of</p>
<p>last name</p></td>
<td>03</td>
<td colspan="8">2. Social Security Number</td>
<td colspan="2">04</td>
<td colspan="12">3. Date of birth <em>(Year and month)</em></td>
<td>05</td>
</tr>
<tr class="odd">
<td colspan="10"></td>
<td></td>
<td colspan="10"></td>
<td colspan="13"></td>
</tr>
<tr class="even">
<td colspan="10">     </td>
<td colspan="3">     </td>
<td colspan="10">     </td>
<td colspan="10">     </td>
<td colspan="3"><p><em>(Example-born</em></p>
<p><em>January 14, 1943</em></p>
<p><em>Shown as 43/01)</em></p></td>
</tr>
<tr class="odd">
<td colspan="13">2. Home address <em>(Number, Street, City, State, Zip
code)</em></td>
<td colspan="10">5. Home telephone</td>
<td colspan="13">6. Position level <em>(Mark (X) one only)</em></td>
</tr>
<tr class="even">
<td colspan="13" rowspan="2">     </td>
<td colspan="4" rowspan="2"><p>Area Code</p>
<p>     </p></td>
<td colspan="6" rowspan="2"><p>Number</p>
<p>     </p></td>
<td colspan="7"> a. Non-supervisory</td>
<td colspan="6"> c. Manager</td>
</tr>
<tr class="odd">
<td colspan="7"> b. Supervisory</td>
<td colspan="6"> d. Executive</td>
</tr>
<tr class="even">
<td colspan="13" rowspan="3"><p>7. Organization mailing address
<em>(Branch-Division/Office/Bureau/Agency)</em></p>
<p>     </p></td>
<td colspan="10">8. Office telephone</td>
<td colspan="7"><p>9. Continuous</p>
<p>civilian service</p></td>
<td colspan="6"><p>10. Number of prior</p>
<p>non-government</p></td>
</tr>
<tr class="odd">
<td colspan="4">Area Code</td>
<td colspan="3">Number</td>
<td colspan="3">Extension</td>
<td colspan="4">Years</td>
<td colspan="3">Months</td>
<td colspan="6">training days</td>
</tr>
<tr class="even">
<td colspan="4">     </td>
<td colspan="3">     </td>
<td colspan="3">     </td>
<td colspan="4">     </td>
<td colspan="3">     </td>
<td colspan="6">     </td>
</tr>
<tr class="odd">
<td colspan="7"><p>11a. Position title/function</p>
<p>     </p></td>
<td colspan="5"><p>11b. Applicant handi-</p>
<p>capped or disabled</p>
<p><em>(See instructions)</em></p></td>
<td></td>
<td colspan="10"><p>12. Pay Plan/series/grade/step</p>
<p>     </p></td>
<td colspan="7"><p>13. Type of appointment</p>
<p>     </p></td>
<td colspan="6"><p>14. Education level</p>
<p>     </p></td>
</tr>
<tr class="even">
<td colspan="36"><strong>Section B - - TRAINING COURSE
DATA</strong></td>
</tr>
<tr class="odd">
<td colspan="14"><p>15A. Name and mailing address of training vendor
<em>(No., Street, City, State, ZIP Code)</em></p>
<p>     </p></td>
<td colspan="22"><p>15b. Location of training site <em>(If same, mark
box)</em> -----------------► </p>
<p>     </p></td>
</tr>
<tr class="even">
<td colspan="36"><p>16. Course title and training objectives
<em>(Benefits to be derived by the Government)</em></p>
<p>     </p></td>
</tr>
<tr class="odd">
<td colspan="2">17. Catalog/Course No.</td>
<td colspan="7">18. Training period <em>(6 digits)</em></td>
<td colspan="2">06</td>
<td colspan="7">19. No. of course hours <em>(4 digits)</em></td>
<td>07</td>
<td colspan="17">20. Training codes <em>(See instructions)</em></td>
</tr>
<tr class="even">
<td colspan="2" rowspan="3">     </td>
<td colspan="2"></td>
<td>Year</td>
<td colspan="3">Month</td>
<td colspan="3">Day</td>
<td colspan="5">a. During duty</td>
<td colspan="3">    </td>
<td colspan="3"></td>
<td colspan="2">Code</td>
<td colspan="10"></td>
<td>Code</td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2">a. Start</td>
<td>  </td>
<td colspan="3">  </td>
<td colspan="3">  </td>
<td colspan="5">b. Non-duty</td>
<td colspan="3">    </td>
<td colspan="3">a. Purpose</td>
<td colspan="2">    </td>
<td colspan="10">08 c. Source</td>
<td>    </td>
<td>10</td>
</tr>
<tr class="even">
<td colspan="2">b. Complete</td>
<td>  </td>
<td colspan="3">  </td>
<td colspan="3">  </td>
<td colspan="5">c. TOTAL ►</td>
<td colspan="3">    </td>
<td colspan="3">b. Type</td>
<td colspan="2">    </td>
<td colspan="10">09 d. Special Interest</td>
<td>    </td>
<td>11</td>
</tr>
<tr class="odd">
<td colspan="36"><h2 id="agency-use-only-1">AGENCY USE ONLY</h2></td>
</tr>
<tr class="even">
<td colspan="15"><strong>Section C -- ESTIMATED COSTS AND BILLING
INFORMATION</strong></td>
<td colspan="21"><strong>Section D -- APPROVALS</strong></td>
</tr>
<tr class="odd">
<td colspan="15">21. Direct costs and appropriation/fund chargeable</td>
<td colspan="11">26a. Immediate supervisor – <em>Name and
title</em></td>
<td colspan="10">Area code/Tel. No./Extension</td>
</tr>
<tr class="even">
<td colspan="3" rowspan="2">Item</td>
<td colspan="3">Amount</td>
<td colspan="9" rowspan="2">Appropriation/fund</td>
<td colspan="11" rowspan="2">     </td>
<td colspan="10" rowspan="2">     </td>
</tr>
<tr class="odd">
<td colspan="3">Dollars Cents</td>
</tr>
<tr class="even">
<td colspan="3">a. Tuition</td>
<td colspan="3">     </td>
<td colspan="9" rowspan="5">     </td>
<td colspan="13" rowspan="2">b. Signature</td>
<td colspan="8" rowspan="2">Date</td>
</tr>
<tr class="odd">
<td colspan="3">b. Books or materials</td>
<td colspan="3">     </td>
</tr>
<tr class="even">
<td colspan="3">c. Other <em>(Specify)</em></td>
<td colspan="3">     </td>
<td colspan="11" rowspan="2"><p>27a. Second-line supervisor – <em>Name
and title</em></p>
<p>     </p></td>
<td colspan="10" rowspan="2"><p>Area code/Tel. No./Extension</p>
<p>     </p></td>
</tr>
<tr class="odd">
<td>d. (Enter 4 digits in</td>
<td colspan="2">12</td>
<td colspan="3" rowspan="2">     </td>
</tr>
<tr class="even">
<td colspan="3"><p>dollar column)</p>
<p>TOTAL ►</p></td>
<td colspan="13" rowspan="2">b. Signature</td>
<td colspan="8" rowspan="2">Date</td>
</tr>
<tr class="odd">
<td colspan="15">22. Indirect costs and appropriation/fund
chargeable</td>
</tr>
<tr class="even">
<td colspan="3" rowspan="2">Item</td>
<td colspan="3">Amount</td>
<td colspan="9" rowspan="2">Appropriation/fund</td>
<td colspan="11" rowspan="3"><p>28a. Training Officer – <em>Name and
title</em></p>
<p>     </p></td>
<td colspan="10" rowspan="3"><p>Area code/Tel. No./Extension</p>
<p>     </p></td>
</tr>
<tr class="odd">
<td colspan="3">Dollars Cents</td>
</tr>
<tr class="even">
<td colspan="3">a. Travel</td>
<td colspan="3">     </td>
<td colspan="9" rowspan="6">     </td>
</tr>
<tr class="odd">
<td colspan="3">b. Per Diem</td>
<td colspan="3">     </td>
<td colspan="13" rowspan="2">b. Signature</td>
<td colspan="8" rowspan="2">Date</td>
</tr>
<tr class="even">
<td colspan="3" rowspan="2">c. Other (Specify)</td>
<td colspan="3" rowspan="2">     </td>
</tr>
<tr class="odd">
<td colspan="21"><h1 id="section-e-approvalconcurrence-1">Section E –
APPROVAL/CONCURRENCE</h1></td>
</tr>
<tr class="even">
<td>d. (Enter 4 digits in</td>
<td colspan="2">13</td>
<td colspan="3" rowspan="2">     </td>
<td colspan="11" rowspan="3"><p>29a. Authorizing Officer – <em>Name and
title</em></p>
<p>     </p></td>
<td colspan="10" rowspan="3"><p>Area code/Tel. No./Extension</p>
<p>     </p></td>
</tr>
<tr class="odd">
<td colspan="3"><p>dollar column)</p>
<p>TOTAL ►</p></td>
</tr>
<tr class="even">
<td colspan="15" rowspan="2"><p>23. Document/Purchase Order/Requisition
No.</p>
<p>     </p></td>
</tr>
<tr class="odd">
<td colspan="11" rowspan="2">b. Signature</td>
<td colspan="6" rowspan="2"><p> Approved</p>
<p> Disapproved</p></td>
<td colspan="4" rowspan="2">Date</td>
</tr>
<tr class="even">
<td colspan="4" rowspan="3"><p>24. 8-Digit station symbol</p>
<p>(Example –12-34-5678) ---------►</p></td>
<td colspan="11" rowspan="3">     </td>
</tr>
<tr class="odd">
<td colspan="21"><h2
id="section-f-certification-of-training-completion-1">Section F –
CERTIFICATION OF TRAINING COMPLETION</h2></td>
</tr>
<tr class="even">
<td colspan="11" rowspan="2"><p>30a. Certifying Official – <em>Name and
title</em></p>
<p>     </p></td>
<td colspan="10" rowspan="2"><p>Area code/Tel. No./Extension</p>
<p>     </p></td>
</tr>
<tr class="odd">
<td colspan="15" rowspan="2"><p>25. BILLING INSTRUCTION <em>(Furnish
invoice to):</em></p>
<p>     </p></td>
</tr>
<tr class="even">
<td colspan="13">b. Signature</td>
<td colspan="8">Date</td>
</tr>
<tr class="odd">
<td colspan="36"><strong>TRAINING FACILITY ► Bills should be sent to
office indicated in item 25. • Please refer to number given in item 23
to assure prompt payment.</strong></td>
</tr>
</tbody>
</table>

**Copy 2 -- Agency (Data Processing or CPDF Copy)** 182-106 Standard
Form 182 (Rev. 12/79) (10-Part)

<table style="width:100%;">
<colgroup>
<col style="width: 13%" />
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 2%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 6%" />
<col style="width: 3%" />
<col style="width: 0%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 4%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 4%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 0%" />
<col style="width: 0%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 0%" />
<col style="width: 2%" />
<col style="width: 1%" />
<col style="width: 0%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 4%" />
<col style="width: 3%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="13" rowspan="4"><p><strong>REQUEST, AUTHORIZATION,
AGREEMENT</strong></p>
<p><strong>AND CERTIFICATION OF TRAINING</strong></p></td>
<td colspan="8" rowspan="2"><p>A. Agency, code agency subelement</p>
<p>and submitting office number</p>
<p><em>(Example - - xx-xx-xxxx)</em></p></td>
<td colspan="2">01</td>
<td colspan="13" rowspan="2"><h2 id="b.-office-use-only-2">B. OFFICE USE
ONLY</h2></td>
</tr>
<tr class="even">
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="10" rowspan="2">     </td>
<td colspan="12">C. Request status <em>(Mark (X) one)</em></td>
<td>02</td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="4"><p>Initial or</p>
<p>Resubmission</p></td>
<td colspan="2"></td>
<td colspan="4">Correction or Cancellation</td>
<td></td>
</tr>
<tr class="odd">
<td colspan="36"><h3 id="section-a-----trainee-information-2">Section A
- - TRAINEE INFORMATION</h3></td>
</tr>
<tr class="even">
<td colspan="10">1. Applicant’s name <em>(Last-First-Middle
Initial)</em></td>
<td colspan="2" rowspan="2"><p>Enter first</p>
<p>5 letters of</p>
<p>last name</p></td>
<td>03</td>
<td colspan="8">2. Social Security Number</td>
<td colspan="2">04</td>
<td colspan="12">3. Date of birth <em>(Year and month)</em></td>
<td>05</td>
</tr>
<tr class="odd">
<td colspan="10"></td>
<td></td>
<td colspan="10"></td>
<td colspan="13"></td>
</tr>
<tr class="even">
<td colspan="10">     </td>
<td colspan="3"></td>
<td colspan="10"></td>
<td colspan="10"></td>
<td colspan="3"><p><em>(Example-born</em></p>
<p><em>January 14, 1943</em></p>
<p><em>Shown as 43/01)</em></p></td>
</tr>
<tr class="odd">
<td colspan="13">2. Home address <em>(Number, Street, City, State, Zip
code)</em></td>
<td colspan="10">5. Home telephone</td>
<td colspan="13">6. Position level <em>(Mark (X) one only)</em></td>
</tr>
<tr class="even">
<td colspan="13" rowspan="2">     </td>
<td colspan="4" rowspan="2"><p>Area Code</p>
<p>     </p></td>
<td colspan="6" rowspan="2"><p>Number</p>
<p>     </p></td>
<td colspan="7"> a. Non-supervisory</td>
<td colspan="6"> c. Manager</td>
</tr>
<tr class="odd">
<td colspan="7"> b. Supervisory</td>
<td colspan="6"> d. Executive</td>
</tr>
<tr class="even">
<td colspan="13" rowspan="3"><p>7. Organization mailing address
<em>(Branch-Division/Office/Bureau/Agency)</em></p>
<p>     </p></td>
<td colspan="10">8. Office telephone</td>
<td colspan="7"><p>9. Continuous</p>
<p>civilian service</p></td>
<td colspan="6"><p>10. Number of prior</p>
<p>non-government</p></td>
</tr>
<tr class="odd">
<td colspan="4">Area Code</td>
<td colspan="3">Number</td>
<td colspan="3">Extension</td>
<td colspan="4">Years</td>
<td colspan="3">Months</td>
<td colspan="6">training days</td>
</tr>
<tr class="even">
<td colspan="4">     </td>
<td colspan="3">     </td>
<td colspan="3">     </td>
<td colspan="4"></td>
<td colspan="3"></td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td colspan="7"><p>11a. Position title/function</p>
<p>     </p></td>
<td colspan="5"><p>11b. Applicant handi-</p>
<p>capped or disabled</p>
<p><em>(See instructions)</em></p></td>
<td></td>
<td colspan="10"><p>12. Pay Plan/series/grade/step</p>
<p>     </p></td>
<td colspan="7"><p>13. Type of appointment</p>
<p>     </p></td>
<td colspan="6"><p>14. Education level</p>
<p>     </p></td>
</tr>
<tr class="even">
<td colspan="36"><strong>Section B - - TRAINING COURSE
DATA</strong></td>
</tr>
<tr class="odd">
<td colspan="14"><p>15A. Name and mailing address of training vendor
<em>(No., Street, City, State, ZIP Code)</em></p>
<p>     </p></td>
<td colspan="22"><p>15b. Location of training site <em>(If same, mark
box)</em> -----------------► </p>
<p>     </p></td>
</tr>
<tr class="even">
<td colspan="36"><p>16. Course title and training objectives
<em>(Benefits to be derived by the Government)</em></p>
<p>     </p></td>
</tr>
<tr class="odd">
<td colspan="2">17. Catalog/Course No.</td>
<td colspan="7">18. Training period <em>(6 digits)</em></td>
<td colspan="2">06</td>
<td colspan="7">19. No. of course hours <em>(4 digits)</em></td>
<td>07</td>
<td colspan="17">20. Training codes <em>(See instructions)</em></td>
</tr>
<tr class="even">
<td colspan="2" rowspan="3">     </td>
<td colspan="2"></td>
<td>Year</td>
<td colspan="3">Month</td>
<td colspan="3">Day</td>
<td colspan="5">a. During duty</td>
<td colspan="3">    </td>
<td colspan="3"></td>
<td colspan="2">Code</td>
<td colspan="10"></td>
<td>Code</td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2">a. Start</td>
<td>  </td>
<td colspan="3">  </td>
<td colspan="3">  </td>
<td colspan="5">b. Non-duty</td>
<td colspan="3">    </td>
<td colspan="3">a. Purpose</td>
<td colspan="2">    </td>
<td colspan="10">08 c. Source</td>
<td>    </td>
<td>10</td>
</tr>
<tr class="even">
<td colspan="2">b. Complete</td>
<td>  </td>
<td colspan="3">  </td>
<td colspan="3">  </td>
<td colspan="5">c. TOTAL ►</td>
<td colspan="3">    </td>
<td colspan="3">b. Type</td>
<td colspan="2">    </td>
<td colspan="10">09 d. Special Interest</td>
<td>    </td>
<td>11</td>
</tr>
<tr class="odd">
<td colspan="36"><h2 id="agency-use-only-2">AGENCY USE ONLY</h2></td>
</tr>
<tr class="even">
<td colspan="15"><strong>Section C -- ESTIMATED COSTS AND BILLING
INFORMATION</strong></td>
<td colspan="21"><strong>Section D -- APPROVALS</strong></td>
</tr>
<tr class="odd">
<td colspan="15">21. Direct costs and appropriation/fund chargeable</td>
<td colspan="11">26a. Immediate supervisor – <em>Name and
title</em></td>
<td colspan="10">Area code/Tel. No./Extension</td>
</tr>
<tr class="even">
<td colspan="3" rowspan="2">Item</td>
<td colspan="3">Amount</td>
<td colspan="9" rowspan="2">Appropriation/fund</td>
<td colspan="11" rowspan="2">     </td>
<td colspan="10" rowspan="2">     </td>
</tr>
<tr class="odd">
<td colspan="3">Dollars Cents</td>
</tr>
<tr class="even">
<td colspan="3">a. Tuition</td>
<td colspan="3">     </td>
<td colspan="9" rowspan="5">     </td>
<td colspan="13" rowspan="2">b. Signature</td>
<td colspan="8" rowspan="2">Date</td>
</tr>
<tr class="odd">
<td colspan="3">b. Books or materials</td>
<td colspan="3">     </td>
</tr>
<tr class="even">
<td colspan="3">c. Other <em>(Specify)</em></td>
<td colspan="3">     </td>
<td colspan="11" rowspan="2"><p>27a. Second-line supervisor – <em>Name
and title</em></p>
<p>     </p></td>
<td colspan="10" rowspan="2"><p>Area code/Tel. No./Extension</p>
<p>     </p></td>
</tr>
<tr class="odd">
<td>d. (Enter 4 digits in</td>
<td colspan="2">12</td>
<td colspan="3" rowspan="2">     </td>
</tr>
<tr class="even">
<td colspan="3"><p>dollar column)</p>
<p>TOTAL ►</p></td>
<td colspan="13" rowspan="2">b. Signature</td>
<td colspan="8" rowspan="2">Date</td>
</tr>
<tr class="odd">
<td colspan="15">22. Indirect costs and appropriation/fund
chargeable</td>
</tr>
<tr class="even">
<td colspan="3" rowspan="2">Item</td>
<td colspan="3">Amount</td>
<td colspan="9" rowspan="2">Appropriation/fund</td>
<td colspan="11" rowspan="3"><p>28a. Training Officer – <em>Name and
title</em></p>
<p>     </p></td>
<td colspan="10" rowspan="3"><p>Area code/Tel. No./Extension</p>
<p>     </p></td>
</tr>
<tr class="odd">
<td colspan="3">Dollars Cents</td>
</tr>
<tr class="even">
<td colspan="3">a. Travel</td>
<td colspan="3">     </td>
<td colspan="9" rowspan="6">     </td>
</tr>
<tr class="odd">
<td colspan="3">b. Per Diem</td>
<td colspan="3">     </td>
<td colspan="13" rowspan="2">b. Signature</td>
<td colspan="8" rowspan="2">Date</td>
</tr>
<tr class="even">
<td colspan="3" rowspan="2">c. Other (Specify)</td>
<td colspan="3" rowspan="2">     </td>
</tr>
<tr class="odd">
<td colspan="21"><h1 id="section-e-approvalconcurrence-2">Section E –
APPROVAL/CONCURRENCE</h1></td>
</tr>
<tr class="even">
<td>d. (Enter 4 digits in</td>
<td colspan="2">13</td>
<td colspan="3" rowspan="2">     </td>
<td colspan="11" rowspan="3"><p>29a. Authorizing Officer – <em>Name and
title</em></p>
<p>     </p></td>
<td colspan="10" rowspan="3"><p>Area code/Tel. No./Extension</p>
<p>     </p></td>
</tr>
<tr class="odd">
<td colspan="3"><p>dollar column)</p>
<p>TOTAL ►</p></td>
</tr>
<tr class="even">
<td colspan="15" rowspan="2"><p>23. Document/Purchase Order/Requisition
No.</p>
<p>     </p></td>
</tr>
<tr class="odd">
<td colspan="11" rowspan="2">b. Signature</td>
<td colspan="6" rowspan="2"><p> Approved</p>
<p> Disapproved</p></td>
<td colspan="4" rowspan="2">Date</td>
</tr>
<tr class="even">
<td colspan="4" rowspan="3"><p>24. 8-Digit station symbol</p>
<p>(Example –12-34-5678) ---------►</p></td>
<td colspan="11" rowspan="3">     </td>
</tr>
<tr class="odd">
<td colspan="21"><h2
id="section-f-certification-of-training-completion-2">Section F –
CERTIFICATION OF TRAINING COMPLETION</h2></td>
</tr>
<tr class="even">
<td colspan="11" rowspan="2"><p>30a. Certifying Official – <em>Name and
title</em></p>
<p>     </p></td>
<td colspan="10" rowspan="2"><p>Area code/Tel. No./Extension</p>
<p>     </p></td>
</tr>
<tr class="odd">
<td colspan="15" rowspan="2"><p>25. BILLING INSTRUCTION <em>(Furnish
invoice to):</em></p>
<p>     </p></td>
</tr>
<tr class="even">
<td colspan="13">b. Signature</td>
<td colspan="8">Date</td>
</tr>
<tr class="odd">
<td colspan="36"><strong>TRAINING FACILITY ► Bills should be sent to
office indicated in item 25. • Please refer to number given in item 23
to assure prompt payment.</strong></td>
</tr>
</tbody>
</table>

**Copy 3 -- VENDOR FILE (COPY)** 182-106 Standard Form 182 (Rev. 12/79)
(10-Part)