Law Enforcement Training Registration Form
Date of Course: Student ID #: ____________________ _______________________
Name:
Last First Middle
Education - Circle Highest Grade Completed:
1 2 3 4 5 6 7 8 9 10 11 12 GED
Gender: Male Female
Employment Circle One: Full Time Part Time Retired Unemployed
Employer Name:
Last 4 of SSN: ____________ Date of Birth:Email:
Phone
#:
Address
Address City State Zip
County of Residence: ______________________ ____________________
_____________________________ ________________
Race/Ethnic Background:
_____________________
_________________________
13 Adult HS Diploma
14 Vocational Diploma
15 Associate Degree
16 Bachelor’s Degree
17 Master’s Degree & Higher
Law Enforcement Fee Waiver:
FCSO
GCSO
VCSO
WCSO
HPD
WPD
NPD
LPD
OPD
BPS
CPS
NCSHP
Other-> ____________
Add agency name
here
2020 Classes (fill in section ID if known)
2020 Firearms Training and Qualification ___ _____
2020 Legal Update ___________
2020 Long-Term Effects of Childhood Adversity _
2020 The Signs Within: Suicide Prevention Education and
Awareness
2020 Career Survival: Training and Standards Issues
___________
Hazardous Materials ____________
Bloodborne Pathogens ____________
Situational Awareness/Subject Control __________
2020 Communication Strategies When Encountering
Persons Who are Deaf or
Hard of Hearing
2020 Armed/Unarmed Security/Company
Police: Understanding Their Roles and Authority
_____________
Law Enforcement Threat Assessment
_____________
Other (enter section ID)
Grade Release: Student's signature on this form gives permission for VGCC to release his/her grade to the appropriate
certification agency, employer or prospective employer, when applicable.
Student Signature: _________________________
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