eCornell Course Application

Employee Information
Date of request:
Employee name:
Current job title:
Name of supervisor:
New or Continuing Student (select one)
This will be my first eCornell course
I have completed eCornell course(s)
Course and Dates

Updated September 7, 2017 Page 1 of 2

 Course Title:
Course Start Date:
Briefly state the relevance of this program study to your current position or career:

Employee Acknowledgement
My signature confirms that I have read and understand the program requirements.

Employee Signature:

Employee Name:
Date:

Supervisor Acknowledgement and Approval

My signature confirms that this learning opportunity is aligned with the staff development plan of the
employee submitting this form and that I approve the request.

Supervisor Signature:

Supervisor Name:
Date:

Application Submission

Send the application packet, comprising this form, with approval signature, and current development
plan to learning@crs.org. Include “eCornell Course Application” in the subject line to ensure prompt
receipt by the HR Learning Team. Incomplete applications will not be considered.

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