IUSB Continuing Education/Information Technologies
Faculty and Staff Computer Training
Registration Form

1. Print out and complete the registration form.
2. Obtain the necessary supervisor approval (Staff only for selected courses).
3. Send the registration form by campus mail or fax to:

Office of Information and Technologies Attention: Beverly Church Fax 574-520-4163

Please Note: only two classes per semester allowed.

Please print. Refer to the Continuing Education homepage (http://www.iusb.edu/~cted) or catalog for section numbers, class dates and times.

Section #                   Class                          Dates/Times

_________  ____________________________________________  __________________

_________  ____________________________________________  __________________


Mr. ____  Ms. ____  Dr. ____  
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Name

__________________________________________________________________
Position/Title

__________________________________________________________________
Division or Department

__________________________________________________________________
Campus Phone

__________________________________________________________________
Division or Department Fax Number

__________________________________________________________________
Home Phone
__________________________________________________________________
E-mail address (Please Print exact address, including capitalization)
__________________________________________________________________
Supervisor Approval (Staff only for selected courses)


FOR OFFICE USE ONLY

__________________________________________________________________
IT Authorization/Date