1CINCINNATI HEALTH DEPARTMENT REQUEST FOR TRAINING

COURSE REGISTRATION FORM

Fill out completely for the training desired and send to Human Resources

Date of Request This request is for: (Please Circle)

Employee Name CHRIS # Office Phone #

HRDA

Safety

In-Service Training

Out-Service Training

Name of Class

ETHICS DVD - SESSION #0001

110019
Office Fax#

Training Course or Name of College Degree Program Course # Training Date(s)

Training Hours Location Are Fees Needed Yes Division Job Classification If degree program, class(es) (Circle) CORE CORE ELECTI VE OWN ELECTI VE Training is related to: PRESENT JOB - REQUIRED PROMOTIONAL OPPORTUNITY CAREER DEVELOPMENT No

Itemized Cost
ITEM Tuition/Registration Books and/or Supplies Transportation Food and/or Lodging Other Total Account to be billed AMOUNTS DEPARTMENT EMPLOYEE

APPROVALS:

Must be approved before this

form goes to Human Resources

Supervisor Signature Date Departm ent/ Division Head Signatur e Date

Date Received in Human Resources Date Entered into CHRIS Date Confirmation sent to employee
DISTRIBUTION: 10/03 Send the original to Human Resources Copy - If fee based attach a copy to this form to your Request for Travel.