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.

Return completed application to:

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

Training and Development Home Page

UCLA Campus Human Resources
Training and Development

February 2005