Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Check the days in which you attended training.
Saturday (1)
Week 1
Sunday (2)
Monday (3)
Tuesday (4)
Wednesday (5)
Thursday (6)
Friday (7)
Saturday (8)
Week 2
Sunday (9)
Monday (10)
Tuesday (11)
Wednesday (12)
Thursday (13)
Friday (14)
Saturday (15)
Week 3
Sunday (16)
Monday (17)
Tuesday (18)
Wednesday (19)
Thursday (20)
Friday (21)
Saturday (22)
Week 4
Sunday (23)
Monday (24)
Tuesday (25)
Wednesday (26)
Thursday (27)
Friday (28)
Saturday (29)
Week 5
Sunday (30)
Week 6
This form must be returned no later than 5th DAY OF THE FOLLOWING MONTH. Failure to return this form may result in the termination of your tuition assistance.
*
My signature certifies the information on this form is true.
Date
*
/
Month
/
Day
Year
Date
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