UCLA CHR Organizational Improvement and Staff Development

Application for Enrollment - General Courses

Course Name:
Course Number:	Begin Date:
Name (Printed):	Employee #:
Department:	Extension:
Campus Address:	Mail Code:
E-mail Address:	Supervisor's Email Address:
Course Fee:	Method of Payment*:
Your Signature:
Signature of Supervisor or Budget Officer (Required):
Printed Name of Authorized Signature Above:

*Payment made by check or department recharge. If paid is Departmental recharge, please include FAU.

Include department FAU number in "Method of Payment" box if paying by department recharge.
Checks should be given to the instructor on the first day of class.
DO NOT send checks or CASH to Training and Development.

Return completed application to:

Training and Development
10920 Wilshire Boulevard, Suite 200
Campus Mail Code 146548

UCLA Campus Human Resources
Training and Development
310.794.0850

February 2005