IRT Generated Form

$33/,&$7,2172REQUEST FOR INNOVATIVE READINESS TRAINING CIVIL-MILITARY PARTNERSHIP 20%&RQWURO1XPEHU
OMB Expiration: XX/XX/XXXX

The public reporting burden for this collection of information, 0704-0583, is estimated to average 330 minutes per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters
Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of
law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control
number. 3/($6('2127 5(7851 <285 )250 72 7+( $%29( 25*$1,=$7,21 5(7851 &203/(7(' )2506
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PURPOSE: This form is to be used by civil organizations or non-military government agencies requesting a civil-military Innovative Readiness
Trainingcivil-military partnership authorized by 10 U.S.C. § 2012. This form may also be used for similar requests under other authorities. Additional
instructions are on page 5. Requests are contingent on military training needs and DOD resourceV
1. REQUEST EXPIRATION DATE

Complete the form below to register and begin your application. Community application for FY20 missions were due September 30,
2018.Community applications for FY21 missions are due by September 30, 2019.Military applications for FY19 missions were due May 1,
2018. Military applications for FY21 missions are due by May 1, 2019.The military services may consider out of cycle requests on a case by
case basis.

SECTION I — REQUESTING ORGANIZATION INFORMATION
2. NAME OF ENTITY REQUESTING MILITARY SUPPORT (Community, Agency, State, Federal Department, Non-Profit Organization, etc.)
3. HAS THIS ORGANIZATION PREVIOUSLY APPLIED FOR AND RECEIVED SUPPORT AND SERVICES FROM THE
DEPARTMENT OF DEFENSE VIA AN INNOVATIVE READINESS TRAINING CIVIL-MILITARY PARTNERSHIP?
4a. WHAT TYPE OF ORGANIZATION DO YOU REPRESENT?

‫܆‬Yes ‫܆‬No

Select

4b. IF A NON-PROFIT, WHICH NON-PROFIT ORGANIZATION DO YOU REPRESENT? Select
5a. STREET ADDRESS OR PO BOX

5b. CITY
5c. STATE

Select

5d. ZIP CODE
SECTION II — PROJECT OVERVIEW
6. PROJECT NAME
7. TYPE OF PROJECT

‫܆‬Healthcare ‫܆‬Construction ‫܆‬Diving ‫܆‬Transporting Items ‫܆‬Aerial Spray ‫܆‬Cybersecurity‫܆‬Other

8. BRIEF PROJECT DESCRIPTIONPD[FKDUDFWHUV

SECTION III — PROJECT LOCATION(S)
9. PHYSICAL LOCATION(S) OF PROJECT (continue in item 51 if needed)
Location

Street Address

City

State

5- digit
Zip Code

Congressional
District

#1
#2
#3
#4
#5
#6
10a. DOES SOMEONE OTHER THAN THE REQUESTING ORGANIZATION OWN THE ABOVE REAL ESTATE OR REAL PROPERTY?

‫܆‬No ‫܆‬Yes, the property is titled to:
10b. ,)File Typeapplication/pdfFile TitleIRT Community Application_Blank.pdfAuthorMandy BirchFile Modified2021-11-16File Created2021-11-15