Request to Repeat Course Due to Legally Mandated Training Requirement.

Instructions:

Please complete this form as soon as possible. Submission of this form does not guarantee enrollment; filled-class policies and current prerequisite requirements apply.You are now required to provide documentation verifying the following requirements: the course is required by statute or regulation as a condition of employment, AND you are employed or actively seeking to be employed for a paid or volunteer job for which the course is required. Please attach documentation to this petition.
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Full Name: Full Name: First Middle Last
Student ID# G00:
IVC Email:
Contact Phone: Contact Phone: - ### - ### ####
The following courses may be repeated due to legally mandated training requirements. Check the course you are wishing to repeat:

The following courses may be repeated due to legally mandated training requirements. Check the course you are wishing to repeat: AJ 141, Arrest and Firearms AHP 060, Health Assistant AHP 062, Home Health Aide EMT/FIRE 105, Emerg. Medical Tech I (if EMT I certification has not been held in the past 4 years) EMT/FIRE 107, Emerg. Med. Tech I Refresher HE 102, Health Education POST 160, RVC Level III POST 162, RVC Level II POST 164, RVC Level I
Term you wish to take the course:
Term Year:
I the undersigned do hereby declare that I need to repeat this course for a legally mandated training requirement as a condition of continued paid or volunteer employment.

Student Signature:

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Full Name

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Request to Repeat Course Due to Legally Mandated Training Requirement.

Request to Repeat Course Due to Legally Mandated Training Requirement.

Instructions: