DHS Logo

Wisconsin Department of Health Services



 
Page 1 of 1
 
 
 

DEPARTMENT OF HEALTH SERVICES
Division of Enterprise Services
F-80475 (01/2014)

STATE OF WISCONSIN
Office of Employee Development and Training

DEPARTMENT TRAINING REGISTRATION

Please have your supervisor's approval to attend a class prior to filling out this form.

If you are applying for the DHS Leadership Institute, you must fill out form F-00939 instead of this form.

Please use a SEPARATE FORM for each training class.

   
1.
*
 
   
2.
*
 
   
 

REGISTRANT INFORMATION

   
3.
*
 
   
4.
 
   
5.
*
 
   
6.
*
Registrant Email addresses must match
 
   
7.
*
Please format as xxx-xxx-xxxx
 
   
8.
*
Complete all applicable fields
 

 

 

 

 

 
   
9.
*
 

 

 

 
   
 

 SUPERVISOR INFORMATION

   
10.
*
 
   
11.
*
 
   
12.
*
Supervisor Email addresses must match
 
   
13.
*
Please format as xxx-xxx-xxxx
 
   
 

PAYMENT INFORMATION

If a registrant fails to appear for class or reschedules less than five working days before the scheduled class date, payment will not be refunded.

   
14.
**Non-DHS employees - your work unit will be invoiced
 
   
15.
 
   
 

REASONABLE ACCOMMODATIONS

All DHS training rooms are physically accessible. If you require accommodations of hearing or visual needs to fully participate in this training event, you must contact the DHS Affirmative Action Office at 608-266-3465 within seven working days of the event. The cost of the accommodation is the responsibility of your employing unit.

   

 
 

For questions, please call OEDT at 608-266-7276.

   
 
Make certain your supervisor knows you are registering for this training before selecting done. Selecting done will submit this form and send a notification to you and your supervisor.
   
 
 
 
 Submit   

* indicates a required field


Protecting and promoting the health and safety of the people of Wisconsin
The Official Internet site for the Wisconsin Department of Health Services