Participant’s Name:

Department:

E-mail:

Employee ID Number (not SSN):

Campus Mailing Address:

Phone:

Name of Supervisor:

Phone:

E-mail:

Campus Mailing Address:

What do you hope to gain from ETC?

All sessions will be held on Tuesday mornings from 9:00 a.m.-12:00 noon in the IMU.

Note: You must have approval from your supervisor to attend this program. Selection for the limited number of spaces in the ETC Program will be based on the order in which completed applications are received. A confirmation and class schedule will be sent to all participants. All other applicants will be placed on a waiting list for future openings.

DUE DATE FOR APPLICATION: September 1, 2009.

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