Employee Learning and Development

Registration Request
(All fields are required in order to submit the request.)

First Name:      

Last Name:      

Employee ID #:

Title:             

Department:  

Telephone:    

Western Email Address:

Campus Address:         

Department Speedcode & Account:   (e.g. AB99 631800)
(Used only if a Withdrawl Fee is charged.)

Please select the program you wish to attend:

You will be notified by email as to the status of your registration request.