FOREST SERVICE CONTINUING EDUCATION PROGRAM
Registration for Enrollment

For:	Non-Forest Service Groups
(State, City, Tribal Organizations, Private Sector, and other Federal Agencies)

Name:  							Date: 
Title:  
Organization: 
Postal Address:  


Phone Number:  					EMAIL: 
FAX NUMBER:  

ACADEMIC EDUCATION

Universities Attended			Degree			Dates			Major/Minor
___________________		______		_____			__________
___________________		______		_____			__________
___________________		______		_____			__________
___________________		______		_____			__________

WORK EXPERIENCE
1. Employing Organization: 
Dates: 		Current Position: 
Short description of duties:

2. Employing Organization: 
Dates:		Highest Position: 
Short description of duties: 


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


What Continuing Education (CE-WFW) workshops 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 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 (shelly.witt@usu.edu). 
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