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I. TMN / Student Name _______________________________ Date _______________________

Advanced Training Opportunity Title_________________________________________________________

Contact information: Name ____________________________ Phone ______________________________

Email: _______________________________________________

Pre-Approved by:

President _____________________________________ Date: ____________________________________

Advisor ______________________________________ Date: _____________________________________

Instructor ___________________________________ Organization / Agency _______________________

Training Location ___________________________________________________________________________

Date of Training ________________________________ Length of Training ______________________(hrs.)

Skills Learned: _____________________________________________________________________________

Knowledge Gained: _________________________________________________________________________

Style: (check all that apply) Lecture ______ Outdoor Training _____ Video _____ Conference _____

TMN Annual Meeting _____Adv. Tr. By TMN _____ Web/Internet Site _____ Hands-on _____

Student’s Evaluation of Training: ______________________________________________________________

Instructor’s Signature (If Possible): _______________________________ Date: ________________________

Or Program / Course Outline Attached

Hours Recorded by Chapter __________ Recorded by: ________________ Date: __________________