Responsible Conference Executive Training Student Data Form




AUTHORIZATION, AGREEMENT AND CERTIFICATION OF TRAINING

In order to register for this course, you will need to fill out the following information.
Trainee Information
First name: Last name: Middle Initial: Date of Birth:

Organization Mailing Address

Medical Center Name: Office Phone #: Work Email Address:


Position Level Non-Supervisory
Manager
Supervisory
Executive

Position Title: Type of Appointment: Education Level:


Other Information

Do you require a special accommodation?


Describe your special accommodation needs.

Continued Service Aggreement Requirement?

Yes
No
N/A




This website assists in describing the policies, roles and responsibilities, and major requirements for Administration and Staff Office implementation of conference planning, execution, reporting, and oversight within the Department of Veterans Affairs (VA) as set forth in Directive 0632, Conference Planning, Execution, Reporting, and Oversight.
Veterans Crisis Line Logo

We’re here anytime, day or night – 24/7 If you are a Veteran in crisis or concerned about one, connect with our caring, qualified responders for confidential help. Many of them are Veterans themselves.
Call 800-273-8255 and press 1
Text 838255
Call TTY if you have hearing loss 800-799-4889
Get more resources atVeterans Crisis Line.

One of the most important things about education is feedback, so make sure and let me know if I did good and what I can do better (because I know this isn't perfect!)