REQUEST FOR SPECIAL

WIDE AREA SITE ACCESS

FOR AN ARMER TALKGROUP

Talkgroup/ Announcement Group Name(s):

If Announcement Group List all Contained Talkgroups:

Sites Requested:

Statewide (Requires Statewide Radio Board Approval)

Other (Specify Sites or Regions):

Talkgroup Owner Agency (Include Point of Contact Information):

Agency Name:
Contact Name:
Address:
Phone:
Email:

Talkgroup or Announcement Group Type (Check all that Apply):

Shared

Private

Special Roaming Only Talkgroup – Occasional Use.

Special Operations Tactical Talkgroup – Occasional Use. If yes, describe or list the	counties or regions covered by a mutual aid agreement, memorandum of	understanding, joint powers agreement, incident response plan or other relevant	agreements here:

Main Dispatch or Tactical Talkgroup – Day to Day Use. If yes, applicant must	demonstrate that the users of this talkgroup conduct their “Normal Day to Day	Business Operations” throughout the requested coverage area. Describe or list the	counties or regions where the users of this talkgroup conduct their “Normal Day to	Day Business Operations” here:

Describe the users, entities or agencies that will operate on this talkgroup:

Describe the type of operations that will occur on this talkgroup:

Describe the anticipated frequency, duration and extent of use of this talkgroup:

Describe why the Statewide Shared Incident Response talkgroups or other shared roaming talkgroups are not suitable to meet these operational requirements:

Talkgroup Owner Agency Authorized Official – Signature & Date

Printed Name and Title