community colleges of baltimore county

THE COMMUNITY COLLEGE OF BALTIMORE COUNTY (CCBC)
STATE OF MARYLAND PRE-RETIREMENT PLANNING SEMINARS SPRING 2015
(For State Agency/State University Employees Only)
State employees within 8 years of retirement and their spouses are eligible to attend the following one-day seminars
which begin at 8:30 a.m. and end at 4:00 p.m. A letter of confirmation will be sent no later than seven business days
prior to your scheduled date.
Please place “1” (first choice) and “2” (second choice) next to the seminar you wish to attend.
SA __
February 20 (Friday)
CCBC, Essex Campus
Essex, MD
SJ __
March 26 (Thursday)
Hagerstown Community College
Hagerstown, MD
ST __
May 7 (Thursday)
CCBC, Catonsville Campus
Catonsville, MD
SB __
February 24 (Tuesday)
300 W. Preston Street
Baltimore, MD
SK__
April 2 (Thursday)
300 W. Preston Street
Baltimore, MD
SU__
May 11 (Monday)
Department of Agriculture
Annapolis, MD
SC __
February 26 (Thursday)
Department of Agriculture
Annapolis, MD
SL__
April 7 (Tuesday)
College of Southern MD
La Plata, MD
CR__
May 12 (Tuesday)
Hagerstown Community College
Hagerstown, MD
(Correctional Officers Only)
SD __
March 4 (Wednesday)
Howard Community College
Columbia, MD
SM__
April 8 (Wednesday)
State Highway Administration
Hunt Valley, MD
SV __
May 15 (Friday)
Towson University
Towson, MD
SE __
March 10 (Tuesday)
Salisbury University
Salisbury, MD
SN__
April 14 (Tuesday)
Frostburg State University
Frostburg, MD
LO __
May 18 (Monday)
Harford Community College
Bel Air, MD
(Law Enforcement - LEOPS Only)
SF __
March 13 (Friday)
Towson University
Towson, MD
SO__
April 16 (Thursday)
CCBC, Catonsville Campus
Catonsville, MD
SW __ May 28 (Thursday)
MD School for the Deaf
Columbia, MD
ASL Provided
SG __
March 17 (Tuesday)
MDOT Headquarters
Hanover, MD
SP__
April 21 (Tuesday)
Mt. Saint Mary’s University
Frederick, MD
SX__
May 29 (Friday)
CCBC, Essex Campus
Essex, MD
SH __
March 18 (Wednesday)
CCBC, Owings Mills Center
Owings Mills, MD
SQ__
April 28 (Tuesday)
MAIF Headquarters
Annapolis, MD
SY__
June 3 (Wednesday)
300 W. Preston Street
Baltimore, MD
SI __
March 19 (Thursday)
Harford Community College
Bel Air, MD
SR__
April 29 (Wednesday)
SZ__
University of MD University College
Largo, MD
SS__
May 5 (Tuesday)
Eastern Shore Hospital Center
Cambridge, MD
June 9 (Tuesday)
CCBC, Owings Mills Center
Owings Mills, MD
For information call: 443-840-1632
Or email: scullip@ccbcmd.edu
SEE OTHER PAGE TO FILL OUT REGISTRATION FORM
STATE OF MARYLAND PRE-RETIREMENT PLANNING
(For State Agency/State University Employees Only)
REGISTRATION FORM – SPRING 2015
For information call: 443-840-1632 or email: scullip@ccbcmd.edu
NAME_____________________________________________________________________________________________________
Last
Suffix
First
Middle Initial
ADDRESS__________________________________________________________________________________________________
Number and Street
City
State
Zip Code
EMPLOYER_____________________________________________
State Agency
DATE OF BIRTH __________________________
(REQUIRED)
Month
Day
Year
WORK PHONE ________________________________________
HOME PHONE__________________________________
EMAIL ADDRESS______________________________
COUNTY OF RESIDENCE _________________________
 □Yes □No
ARE YOU A STATE EMPLOYEE?
ARE YOU A MEMBER OF ANY OF THE FOLLOWING PENSION SYSTEMS?
□ Correctional
Will spouse attend?
□Yes □ No
□ Law Enforcement (LEOPS)
□ State Police
If Yes, please complete the following information:
Spouse’s First name:__________________________
Spouse’s Last Name: ________________________
Employee’s Signature_________________________________________ Date________________
(Required)
(I authorize CCBC to release this information to the State of Maryland)
Please indicate any special assistance required for a handicapped condition.___________________________
________________________________________________________________________________
Are you of Hispanic or Latino origin?
□ Yes □ No
What is your race? Select one or more of the following categories:
□White
□Black or African American
□Asian
□American Indian or Alaska Native
□Native Hawaiian or Other Pacific Islander
SUBMIT YOUR COMPLETED FORM:
EMAIL:
scullip@ccbcmd.edu (must email a signed copy)
OR
FAX:
443-840-1856 (Attention Sarah Cullip)
OR
http://www.ccbcmd.edu/ceed/preretirementstate/
OR
ONLINE:
MAIL TO:
The Community College of Baltimore County (CCBC) For Office Use Only:
Pre-Retirement Planning Registration, BESS 116
Course # MAN 969_______
7201 Rossville Boulevard
Date: __________________
Baltimore, MD 21237