LTD Request Form

Please complete all relevant fields on the LTD request for us to schedule an appointment and assess your needs.

Name:

PeopleSoft ID:

Department:

E-mail Address:

Phone Number:

Type of Training:

Preferred Training Start Date:MonthYear

Preferred Training End Date:MonthYear

Total # of Employees:

Employee Status:

Best Day for Training:

Best Time for Training:

What is the nature of the situation that you wish to be addressed?:

What are the desired outcomes?:

Additional Comments:

Human Resources