Indiana University
Revised: 6 June 2012 University Human Resource Services

Excellence Training Certification for Support Staff
Application Form 2012 -2013

After you have completed this form, please PRINT it and send to:
Organizational Development
University Human Resource Services
400 E. 7th Street, Poplars E165

Participant’s Name:

Department:

E-mail:

Employee ID Number (not SSN):

Campus Mailing Address:

Phone:

Supervisor Information

Name of Supervisor:

Phone:

E-mail:

Campus Mailing Address:

What do you hope to gain from ETC?

Note: You must have approval from your supervisor to attend this program. Selection for the limited number of spaces in the ETC Program will be based on the order in which completed applications are received. A confirmation and class schedule will be sent to all participants. All other applicants will be placed on a waiting list for future openings.

PRINT and mail to the address above.

DUE DATE FOR APPLICATION: August 1, 2012.

 

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