Georgia Juvenile Justice Training Academy



Georgia Department of Georgia Juvenile Justice

Office of Training

Training Request Form

Requesting Agency (Circle one: DJJ **Private Other)

THIS REQUEST SHOULD BE COMPLETED AND FORWARDED TO THE ADDRESS LISTED BELOW. CONFIRMATION LETTERS AND INSTRUCTIONS WILL BE E-MAILED TO THE NAMED SUPERVISOR AND THE PARTICIPANT.

Course Title:___________________________ Course Dates:__________________________

(Proof of completion of prerequisites must accompany request form.)

Name:________________________________ E-mail Address:_________________________

Employee ID#:__________________________ Social Security #:________________________

Home Address:________________________________________________________________

Name of Office/Facility: __________________________________________________________

Office Address: ________________________________________________________________

Fax#:_________________________________ Phone: ________________________________

Merit System Title: _______________________ Employment Date: _______________________

Gender:______ Lodging Requested*: (circle one) _ Yes No__

*If you live or work 50 or more miles from the

training site, you may eligible for lodging.

Supervisor’s signature states that prerequisites for this program are complete for applicant.

Supervisor: (Please Print) _____________________________________

Supervisor’s Signature:_____________________________________

Supervisor’s E-mail Address: ________________________________

Supervisor’s Telephone #:___________________________________

****Indicate any disability accommodation or special meal requirement needs.

**If other than a state employee, in the space provided below, please give name and address of the agency responsible for the cost of this training.

Private: Send To: DJJ Registrar

Agency:__________________________ Georgia Juvenile Justice Training Academy

Agency Address:___________________ 1000 Indian Springs Drive

________________________________ Forsyth, Georgia 31029

FEI #____________________________ Phone: (478) 993-4660

Fax: (478) 993-3016

Date Received: (Academy Use Only)

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Revised10/12/06

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