TABE 701 12.2.09 St. Petersburg

Date: December 2, 2009

Time: 9:00-1:00

Location:
12425 28th Street North, Suite 300
St. Petersburg, FL 33716
Phone: 727-556-3000

TABE 701 is for experienced TABE test administrator who has already received his or her initial certificate and is fulfilling the recommended re-certification.

Trainer: Jiske Ong

1. Attendee Last Name

Attendee Last Name

2. Attendee First Name

Attendee First Name

3. E-mail Address

E-mail Address

4. Title/Position (i.e., GED instructor, Volunteer tutor, etc.)

Title/Position (i.e., GED instructor, Volunteer tutor, etc.)

5. Name of your school/agency/organization

Name of your school/agency/organization

6. County

County

7. Mailing Address (Street)

Mailing Address (Street)

8. City

City

9. State

State

10. Zip

Zip

11. Telephone Number (with area code)

Telephone Number (with area code)

12. I have received authorization from my supervisor to attend this training

I have received authorization from my supervisor to attend this training Yes

13. My supervisor's name is

My supervisor's name is

14. My supervisor's email address is

My supervisor's email address is

15. PLEASE NOTE: Travel requests must be submitted by Wednesday, Nov. 17th. Requests received after Nov. 17th cannot be processed.

I will not be reimbursed by my organization and am requesting travel reimbursement from The Region IV Training Council for

PLEASE NOTE: Travel requests must be submitted by Wednesday, Nov. 17th. Requests received after Nov. 17th cannot be processed. I will not be reimbursed by my organization and am requesting travel reimbursement from The Region IV Training Council for mileage (available only for those traveling over 25 miles one way @.445 cents per mile)

mileage plus hotel (available only for those traveling over 50 miles one way, room rate approximately $120)

16. If you have requested travel reimbursement (Question 15), please provide your HOME ADDRESS including city and zip code.

If you have requested travel reimbursement (Question 15), please provide your HOME ADDRESS including city and zip code.

17. Questions or comments:

Questions or comments: