State of Connecticut CEUI Technical Course Seat Request

Name*
First Last
UConn Health Email address*
Phone Number*
In case you need to be notified off work hours, please indicate an alternate number.
Date of Hire*

Enter your date of birth as shown. CEUI requests your date of hire on your application.
Length of Service*

CEUI requests you enter your length of service. Please enter numbers only.
Course Name*

Example: Welding II
Course Number*

Example: AS15231
Course Fee*

Enter the course fee as listed in the In-Service Catalog - eg. $285
Course Delivery*
Select how the course will be delivered.
Name of Community College Offering Course*
Select the name of the community college from the dropdown
Room Number*
Instructor Name*
Course Duration*

Enter the number of days of the course.
Course Start Date*

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

Enter the Course End Date. If this course is only one day, leave field blank.
Have you met the prerequisites for your selected course?
- Yes
- No
- No Prerequisite Required
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's Email*
Enter Email Confirm Email
In-Service CEUI Training Registration Agreement
I certify I have discussed my application for State In-Service CEUI technical training with my manager/supervisor.
In-Service Training Registration Agreement*
- Yes
Phone
This field is for validation purposes and should be left unchanged.

Human Resources

State of Connecticut CEUI Technical Course Seat Request Form

Fill out the form below to request a seat in a Fall 2023 State of Connecticut CEUI Technical course. The deadline to register is September 29.

Manager/Supervisor Notification

In-Service CEUI Training Registration Agreement