State In-Service Seat Request

Name*
First Last
UConn Health Email address*
Cell Phone Number*
A number that you can be reached directly.
Home Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Course Name*

Enter the course name as listed in the In-Service Catalog - eg. Communications Skills a Must!
Course Number*

Enter the course number as listed in the In-Service catalog - eg. AS15231
Course Start Date*

Enter the Course Start Date as listed in the In-Service catalog.
Course Fee*

Enter the course fee as listed in the In-Service Catalog - eg. $285
Name of Community College Offering Course*
Select the name of the community college from the dropdown
Community College NETID

If you have previously participated in an In-Service course at a community college, you may have been provided a NETID by the community college for registration purposes. If you know this number, please enter it here. If, not, please leave this field blank. If you have previously taken classes, you may find your ID on http://supportcenter.ct.edu/netid/lookupnetid.asp
Payment*
Seats are not reserved without payment. Upon submitting this form, you will receive an email with directions to provide your transfer voucher or personal check to Etta Henderson by the deadline. No exceptions.
Manager/Supervisor Notification
Your manager/supervisor will receive an email notification of this training request made by you. You must speak with your supervisor prior to submitting this form and confirm use of department or personal funds for payment, as well as accounting for time away from work to attend the course.
Manager/Supervisor's Name*
First Last
Manager/Supervisor Title*
Manager/Supervisor's Email*
Enter Email Confirm Email
Manager/Supervisor's Phone*
In-Service Training Registration Agreement
I certify I have discussed my application for State In-Service training with my manager/supervisor. I further certify that my supervisor has approved my training request before this request submission, including the use of department funds (if applicable) to pay for the course and how to account for time away from work to attend the course.
In-Service Training Registration Agreement*
- Yes
Comments
This field is for validation purposes and should be left unchanged.

Human Resources

State In-Service Registration Form

Fill out the form below to request a seat in a Spring 2025 State of Connecticut In-Service course.

Manager/Supervisor Notification

In-Service Training Registration Agreement