CYPRIAN LEARNING CENTER REGISTRATION FORM

Please print clearly and complete all sections of this registration form.
Please discuss your training needs with your supervisor.  
Some departments have an internal screening process to approve training registration

Course Title:  _______________________________________ Course Date(s): ________________ Cost:__________________
Employee Name: ____________________________________ Employee #: _________________________________________
Job Title: _________________________________________ Dept:____________________  Div:______________________
Work Address:_____________________________________ City, Zip:____________________________________________
Phone #:__________________Fax #:_____________________ E-Mail:_____________________________________________

Are you currently supervising other staff? Yes ___ No___

Name of Immediate Supervisor:___________________________ Signature of Supervisor:________________________________

If there is a charge for this course and/or textbooks, 
you must obtain the signature of the individual in your department who approves expenditures.

Authorizing Signature for Expenditures:________________________________________________________________________

Verification of Attendance: Instructor's Signature _______________________________________________________________
PLEASE NOTE: If you cannot attend a class, you must notify the Cyprian Learning Center ten working days prior to the start of the class. We must charge the course fee listed in our catalog if ten working days notice is not given. Substitutes may be sent to replace the original registrant.

Please use one of these forms for each course you plan to attend.
Photocopies of the registration form are acceptable.
Directions to District Office Sites will be included in the confirmation letter or e-mail.

YOU SHOULD KNOW:
PRegistrations are accepted on a first-come, first-served basis unless otherwise noted.

PYou will receive a letter or e-mail confirming your enrollment in the course listed above or informing you that the class
       is full. If the course is full, please look for it in our next catalog. We do not maintain a waiting list.

PWe require a minimum number of registrants to run a course. If the minimum number is not reached ten working days
       before the course begins, we will inform you in writing, by telephone, or e-mail of the cancellation.

PIf you require any special accommodations for training, please call the Cyprian Learning Center (241-1114) prior to
         the start of the course

Mail Registrations to:
Cyprian Learning Center
103 South Main Street - Osgood Building
Waterbury VT 05671 - 2801


Or Fax Registrations to:

241-1119