State In-Service 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.
Course Selection*
Additional Course Selections?
Additional Course Selection
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 Feb. 14 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's Email*
Enter Email Confirm Email
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