Environmental Training Institute
Dept. of Civil & Env. Engr.
University of Cincinnati
P.O. Box 210071
Cincinnati, Ohio 45221-0071
Phone: (513) 556-2542
FAX: (513) 556-2599
E-MAIL: sumana.keener@uc.edu
APPLICATION FOR TRAINING
(P LEASE P RINT OR TYPE)
1. Name of Applicant (First, Middle, Last)
______________________________________________________________________________
2. Course Number/Title/Date
_____________________________________________________________________________
3. Sponsor or Employer Address 4. Phone/Fax Number/E-mail Address
_____________________________________________________________________________
5. Mailing Address (Only if different from 3.)
_____________________________________________________________________________
6. Educational Background
_____________________________________________________________________________
7. Position Title and Experience
_____________________________________________________________________________
8. Signature of Applicant 9. Date
___________________________________________________________________________
Tuition fee (when applicable) should accompany the completed application. Please make check
payable to the University of Cincinnati ETI.
Please be aware that all cancellations must be made one week prior to the first day
of the course. After that date, cancellation will cause a $50 course material fee to be
assessed.
Please mail or fax the completed application form to:
Dr. Sumana Keener, P.E. , Q.E.P.
Dept. of Civil & Env. Engr.
University of Cincinnati
P.O. Box 210071
Cincinnati, OH 45221-0071
Fax (513) 556-2599
C:\ETI\Application\Application Form