Form 3-2570 Native Youth Climate Adaptation and Leadership Congress

FWS Form 3-2570 (Rev. 08/2023)
U.S. Department of the Interior

OMB Control No. 1018-0176
Expires ##/##/20##

NATIVE YOUTH CLIMATE ADAPTATION LEADERSHIP CONGRESS
TRAVEL INFORMATION
U.S. Fish and Wildlife Service
National Conservation Training Center

RETURN THIS FORM ASAP ONCE YOU ARE 100% SURE THAT STUDENTS
WILL BE ABLE TO ATTEND THE CONGRESS – TRAVEL INFORMATION
DOES NOT HAVE TO WAIT FOR OTHER FORMS
Congratulations on having your group chosen to attend the Native Youth Climate Adaptation Leadership Congress.
New Mexico Wildlife Federation will be handling all of the travel, safety, medical and behavioral logistics for the
conference. Below is some information we will need to make all of the travel arrangements for the conference.

PLEASE BE AWARE THAT BY COMPLETING THIS INFORMATION, YOU ARE AGREEING TO ATTEND THE
CONFERENCE. AIRFARE IS NON-REFUNDABLE AND ONCE BOOKED, TICKETS CANNOT BE CHANGED. PLEASE
MAKE SURE INFORMATION IS ACCURATE AND STUDENTS ARE ABLE TO ATTEND.

Chaperone Name (as shown on ID):

Address:
DOB:

Cell Phone:

Email Address:
Group/School/Community Name:
Participants Name As Shown On ID
Please put a / between first/middle/last name:

Date of Birth

Phone Number:

Sex: (Required by Airline)

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FWS Form 3-2570 (Rev. 08/2023)
U.S. Department of the Interior

OMB Control No. 1018-0176
Expires ##/##/20##

Airport in which you will be flying out of:

Are there any participants that need special travel arrangements?

Students and chaperones will receive a travel stipend to pay for luggage fees and any incidentals
while traveling. The stipends will be sent as pre-paid Visa cards. As chaperone, you will be responsible
for distributing these cards to your students. Please provide an address where we can send these
cards in mid-June.

Any other comments, questions, things we need to know about:

If you have any questions or concerns or need to change any information, please contact Wendy
Sandidge at [email protected] or 505-366-7577. We look forward to meeting you at the
conference.

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FWS Form 3-2570 (Rev. 08/2023)
U.S. Department of the Interior

OMB Control No. 1018-0176
Expires ##/##/20##

NOTICES
PRIVACY ACT STATEMENT
Authority: The information requested is authorized by the Government Organization & Employee Training Act (5 U.S.C. 4101, et
seq.), Executive Order 11348 (Providing for Further Training of Government Employees), Americans with Disabilities Act and the EGovernment Act of 2002, (42 U.S.C. 112101) and the E-government Act of 2002 (44 U.S.C. 3501).
Purpose: To enroll students for National Conservation Training Center (NCTC) hosted programs.
Routine Uses: The information on this form may be used by program leaders to contact those selected for the NYCALC program.
Information may be disclosed to the Department of Justice (DOJ), a court, adjudicative or other administrative body, the fiscally
sponsoring organization or agency of the student, a party in litigation before a court or adjudicative or administrative body; or any DOI
employee when represented by DOI or DOJ for legal proceedings or as required by law pursuant to the routine uses identified in the
System of Records Notice: DOI Learn, INTERIOR/DOI-16 available at https://www.doi.gov/privacy/doi-notices.
Disclosure: Providing the requested information is voluntary. However, failure to provide the information may prevent participation in
the program.
PAPERWORK REDUCTION ACT STATEMENT
In accordance with the Paperwork Reduction Act (44 U.S.C. 3501, et seq.), the U.S. Fish and Wildlife Service collects information to
assure the health and safety of participants while on site at the National Conservation Training Center for the Congress. Your response
is voluntary and we will not share your response publicly. We may not conduct or sponsor and you are not required to respond to a
collection of information unless it displays a currently valid OMB Control Number. OMB has reviewed and approved this information
collection and assigned OMB Control Number 1018-0176.
ESTIMATED BURDEN STATEMENT
We estimate public reporting for this collection of information to average 20 minutes, including time for reviewing instructions, gathering
and maintaining data and completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of
the form to the Service Information Clearance Officer, Fish and Wildlife Service, U.S. Department of the Interior, 5275 Leesburg Pike,
MS: PRB (JAO/3W), Falls Church, VA 22041-3803, or via email at [email protected]. Please do not send your completed form to this
address.

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