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