State of Connecticut CEUI Technical Course Seat Request Form

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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
Email

This field is for validation purposes and should be left unchanged.

First Name*

Last Name*

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

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?*YesNoNo 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

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State of Connecticut CEUI Technical Course Seat Request Form

See topics forProfessional Development

State of Connecticut CEUI Technical Course Seat Request Form

Fill out the form below to request a seat in a Spring 2024 State of Connecticut CEUI Technical course. The deadline to register is February 28.

Manager/Supervisor Notification

In-Service Training Registration Agreement

Course Delivery

Manager/Supervisor Notification

Manager/Supervisor's Name

Manager/Supervisor's Email

In-Service CEUI Training Registration Agreement