Date:
Name:
Payroll
Number:
Home address:
E-mail address:
Providing an e-mail address
allows us to e-mail you ICD
updates.
Phone number:
Department:
Position title:
Course name:
Start Date:
End Date:
Cost:
Address
City
If you cannot attend the first class you must notify ICD prior to the first class. You
can do this by calling Jessica Carpio at 439-6189 or e-mailing her at
jcarpio@ussposco.com. Failure to notify may cause you to forfeit your allocated
funds for the class or your registration in the class.
I authorize the course vendor(s) of the course(s) listed above to release any
information requested by UPI Career Development regarding tuition paid,
attendance, and completion of courses.
Printable
Form
Active Employee
Customized Course Registration
ICD
