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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