R174-1-503

What is the name of the agency?

What is the purpose/role of your organization?

Are there different divisions or departments which your agency is seeking radio coverage for?

Are you a public agency/political subdivision of the state?

Yes

No

How many BeON licenses are you seeking to add to the public safety radio system?

What is the public safety purpose for which you are seeking to use the public safety radio system?

What is the name of the sponsoring entity?

Please upload a signed approval from an authorized representative of the sponsoring entity requesting your participation on the public safety radio network.

Please state the public safety purpose for which your admission is requested.

If you have one, please upload a copy of a written agreement allowing your participation on the public safety radio network, such as a contract with UCA.

What is the estimated number of radios anticipated for the agency for a period running from the next July 1 for the following five (5) years.

Who is the authorized person who is completing this application (please provide a name, phone number, email address, and physical address of the requesting agency/entity)?

Attachment - Sponsorship letter from a fire fighting agency, law enforcement agency, or public medical provider.

Attachment - Agency application letter or additional comments.