Internal Training Request Form

INTERNAL TRAINING REQUEST FORM City of Madison Organizational Development and Training Room 302, Madison Municipal Building, 266-4281

Instructions: - Complete items 1-11. - PRINT and return form to above address.	A copy of this form will be returned to the employee to: - Confirm registration. - Indicate placement on a waiting list. - Indicate if course was completed.

Please provide the following information:

1.	First Name
2.	Last Name
3.	Department
4.	Address (W)
5.	Phone (W)
6.	E-mail
7.	Course
8.	Account Number
9.	Date, Time
10.	Location
11.	Supervisor's Signature
		Supervisor's signature needed for approval.
12.	E-mail
13.	Choose One	Current Job Training Future Job Training
14.	Choose One	Manager / Mid-Manager Supervisor / Leadworker Professional Fieldworker / Laborer Paraprofessional / Clerical Support Hourly / Seasonal
15.	Accommodations (Select all that apply)	Wheelchair Accessibility Visual/Hearing Aids Interpreter

FOR TRAINING OFFICE ONLY
Reservation Accepted Enrollment Filled/Named Placed on Waiting List Course Completed Course Incomplete	Course Canceled Employee Canceled No Show