Please mail this form. If FAXed or e-mailed, please also mail the original form, thank you.
2009-2010 Registration - Please read this page!
First two meeting dates: Monday, August 31 and Monday, September 14, 2009 from 5:00-8:00 p.m. local time
PLEASE hand a COPY of this form to the SITE OSI INSTRUCTOR and SEND the ORIGINAL to:
Dr. David NickolichTEL:317. 278.0631
WS Program, ET 309-G, IUPUI FAX:317.278.3669
799 West Michigan
Indianapolis, Indiana 46202
Please visit the WS I Training Program Web site for class information. The updating of that Web site starts in July 2009 until it is current.
As we process the WS I registrations for 2009-2010, the names of these WS I teachers will appear on the rosters for their face-to-face class location at the WS I Training Program Web site We try our best to honor the location of first choice.
I will send a Welcome e-mail, personalized to each WS I teacher enrolled, to the e-mail account listed on the registration forms as "to be used for this class." This e-mail will explain to the WS I teacher to go to the above Web site for directions to the face-to-face training location & and other information such as the class schedule (you can give them the Web site now, if you wish.) Teachers will not receive anything from us via U.S. postal mail.
The Welcome e-mail from me will also ask each WS I teacher to look for a second e-mail coming the teacher’s way, from Indiana University (I. U.) Account Management. This I.U. Account Management (AMS) e-mail will ask the teacher to click a link in that I. U. e-mail and supply the ID and password (that I listed in my Welcome e-mail), as this process activates the teacher’s I. U. Guest Account.Each teacher has a unique ID and password. Completing this process is absolutely necessary to do, as it will allow the teacher can get into the online portion of the class, starting on August 31st.Then the teachers should reply to my Welcome e-mail saying that they did this activation, so we can check the teacher’s access to the class, to make sure all is working well. Instruction will be given on August 31st for how to get into the online class system, and the online portion of the class is not available before then.
Please note that WS I teacher names should typically appear on the Web site before these two e-mails are sent.Teachers will receive the two e-mails within a few days of us processing this form. We will also require teachers and mentors to attend the IACTE Conference sessions on Friday, September 25, 009 in Indianapolis. Plan on subs for that day. More details will follow.
The WS I Registration Form starts on the NEXT page. That is the only page that needs to be returned. It is very, very important to provide the WS I teacher’s working e-mail address. This can be a person e-mail address; it does NOT need to be a school e-mail address. The e-mail address provided must be working and the WS I teacher should be logging on each day to see if we have sent email.
Workplace Specialist I Training Program
Employment Verification and Registration Form 2009-2010
Please return this form so that it is received no later than Thurs., August 27th. For late hires, FAX or e-mail this formand call the number below.
ALL FORMS MUST BE TYPED or WORD PROCESSED- Download from
OSI Teacher Name ______/______
(Last) (First)(MI) (SS#)
Street address:______
City, State, & ZIP______
Home telephone ( ) ______School telephone ( )______FAX ( )______
E-mail to be used for this class (absolutely required)This E-MAIL ID MUST BE WORKING NOW. This can be a personal e-mail address. You will receive e-mail that must be read and action must be taken per instructions to continue in this program. ______
Alternative e-mail address (if any) ______
WSI License #______(If not received – date of application) _____/ _____ /_____
NOTE: Not occupational license number – example not cosmetology board license or nursing license.
Program/occupational area______Date of employment _____/_____/_____
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Please note: Instructors of adult classes do not qualify for OSI Program or Teacher Certification
School corp. or agency______Building______
Address______City & ZIP______
Building address if different than above______
Career and technical director______e-mail______
Alternative administrator, if any______e-mail______
Agency/administrator(s) telephone(s) ( )______ext.______
Mentor’s name______SS#______
(Required for payment, canbe provided later)
Mentor’s home address______
Mentor’s city, state, & ZIP______
*************************************************************************************
There will be three sessions conducted at remote (face-to-face training) sites.
Please rank these sites in order of preference by indicating with numbers 1 through 4 with 1 being the most preferred. Enrollment capacity is limited at each site. Every effort will be made to assign teachers to their first preference, but it may be necessary to assign some to another site if the first preference is full.
__Northern Indiana (Valparaiso - Porter County Career & Technical Center)
__Southern Indiana (New Albany - Prosser) __South Indianapolis (Greenwood - Central Nine Career Center)
__Northeast Indianapolis (Walker Career Center)
All information on this form is required except the alternative e-mail or alternative administrator, when not applicable.
First two meeting dates: Monday, August 31 and Monday, September 14, 2009 from 5:00-8:00 p.m. local time
PLEASE hand a COPY of this form to the SITE OSI INSTRUCTOR and SEND the ORIGINAL to:
Dr. David NickolichTEL:317. 278.0631
OS Program, ET 309-G, IUPUI FAX:317.278.3669
799 West Michigan
Indianapolis, Indiana 46202For class information, please visit: