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.
Thursday (1)
Friday (2)
Saturday (3)
Week 1
Sunday (4)
Monday (5)
Tuesday (6)
Wednesday (7)
Thursday (8)
Friday (9)
Saturday (10)
Week 2
Sunday (11)
Monday (12)
Tuesday (13)
Wednesday (14)
Thursday (15)
Friday (16)
Saturday (17)
Week 3
Sunday (18)
Monday (19)
Tuesday (20)
Wednesday (21)
Thursday (22)
Friday (23)
Saturday (24)
Week 4
Sunday (25)
Monday (26)
Tuesday (27)
Wednesday (28)
Thursday (29)
Week 5
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
*
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Month
/
Day
Year
Date
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