Office of

State Training & Organizational Development

Bureau of Human Resources

'Partners in Learning'

Course Enrollment Form

Title of Program: __________________________________________________________________

Date preference:_____________ Alternative date:_____________

Program Location: ________________________________________ Fee:______________________

Last Name: ________________________________ First Name: _____________________________

Position Title: _____________________________________ TAMS ID: A_____________________

Dept./Agency:__________________________________ Bureau/Division: ___________________

Work Phone _____________________

E-Mail address (if not on State system) ________________________________________________

Immediate Supervisor ________________________________________________________________

I have carefully read the description of the program for which I am applying. I understand and agree

with the Office of State Training & Organizational Development Cancellation policy:

Registrant's Signature _________________________________________ Date ___________

Supervisor's Signature _________________________________________ Date ___________

If you require special arrangements/accommodations, please contact the Office directly in advance of the course.

Return to: Office of State Training & Organizational Development

#4 State House Station

Augusta, ME 04333-0004

Main Office Tel: 624-7764 Fax: 287-4414 TTY: 1-888-577-6690

http://www.maine.gov/bhr/statetng

rev. 9/09