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educationcommittee@cupe109.ca
26 James Street
Kingston, ON K7K 1Y9
613-544-2291
EDUCATION COMMITTEE REQUEST FORM
Name:
Email Address/Phone #:
Designation (location):
Job:
Supervisor:
Educational/ Conference/ Convention Selection:
______________________________________________________________________
Have you attended this in the past (when):
______________________________________________________________________
Educational Course Description/Choice:
Location:
Date:
Is there a prerequisite? Have you completed this? Yes___________________
List Previous related courses:
What courses have you attended to date (list all):
______________________________________________________________________
Number of General Membership Meetings attended to date
(For the past 12 months to date)? ____
Why do you want to attend? ________________________________________
Education Committee Recommendation: (YES/NO)
If no – Why: ______________________________________________________________
