Western Kentucky University

CWD: Simpson Co. Training Consortium

Class Registration Form

Onsite (classroom) Courses

1st Quarter, 2013

• You will receive confirmation of your registration via e-mail.
IMPORTANT: You must use the drop-down menus to fill in the registration form.

  (Used to fill in the course and company information)

Submit this form ONCE for EACH employee being registered.

(Leave blank if not known.)
The employee is a Kentucky Resident.
(Leave blank if not known.)
(if any):*
By checking this box, I certify that the enrolled employee has given permission for his/her name to be viewed in class enrollment reports. No other personal information will be listed in enrollment reports. (NOTE: The form cannot be submitted unless this box is checked.)
*NOTE: Please fill out "Number of employees waiting to enroll" ONLY on your 5th employee enrollment, during the 2-week limited enrollment time period. This will help prevent an over-estimation of additional training needs.
 Last Modified 5/13/14