Registration Form for non-FS participants

FOREST SERVICE CONTINUING EDUCATION PROGRAM

Registration for Enrollment

For: Non-Forest Service Groups

(State, City, Tribal Councils/Nations, Private Sector, and other Federal Agencies)

Please return this form to Shelly Witt, USDA Forest Service, 860 North 1200 East, Logan UT 84321. Registration forms will be handled on a first come, first served basis for qualified applicants.

Name:
Title:
Organization:
Postal Mailing Address:

Phone Number	Email:
Fax Number:

ACADEMIC EDUCATION

Universities Attended

Degree

Dates

Major/Minor

________________________ ______ _________ _____________________

WORK EXPERIENCE

1. Employing Organization _______________________________________________

Date ____________

Highest Position Held _______________________________________________________________________

One sentence description of duties _______________________________________________________________________

2. Employing Organization _______________________________________________

Date ____________

Highest Position Held _____________________________________________________________________

One sentence description of duties__________________________________________________________________

PROFESSIONAL ACTIVITIES (The Wildlife Society, American Fisheries Society, etc.)

_____________________________________________________________________________

In a single brief paragraph state why you are interested in the workshop.

_____________________________________________________________________________

What Continuing Education (CE-WFRP) workshop have you previously attended? NONE: __

1. _________________________________________________________________________

2. _________________________________________________________________________

3. _________________________________________________________________________

4. _________________________________________________________________________

List in priority your choices of workshops

Priority 1: ______________________________________________________________________

Priority 2: ______________________________________________________________________

Priority 3: ______________________________________________________________________

If associated with a Tribal organization, are you applying for a scholarship? Yes ___ No ___

If YES, do you still want to attend the requested workshop(s) if a scholarship is no longer available?

Yes ___ No ____

Applicant Signature __________________________________________ Date _________________

Supervisor Signature of Approval __________________________________________________

Date: ______________________________

We consider submission of this form confirmation of your attendance, and you are sending the tuition payment to the host institution, ASAP. If you must drop from the workshop after being confirmed, please find a sub or pay fixed costs (unless other arrangements are made with the host institution). Fixed costs vary per workshop. Registration forms will be handled on a first come, first served basis for qualified applicants. You will be contacted via email or postal mail regarding confirmation. If you do not receive e-mail confirmation, please contact Shelly Witt at 435-881-4203. The e-mail system may be down and your registration not received

If you are downloading this form from the program web site or received the form electronically, please return the completed form to Shelly Witt (switt01@fs.fed.us).

If you have a hard copy of the form please return it to Shelly Witt at:

Shelly Witt

USDA Forest Service

860 North 1200 East

Logan UT 84321

Office Use Only

TSR Yes No

Notified Yes Date:

Confirmed Yes Date:

Vendor Notified Yes
Date

Updated 3/07

Office Use Only
TSR	Yes	No
Notified	Yes	Date:
Confirmed	Yes	Date:
Vendor Notified	Yes	Date
Updated 3/07