AZ POST Form PA (Revised June 2020)
ARIZONA PEACE OFFICER STANDARDS AND TRAINING BOARD
PROGRAM COMPLIANCE CONFIRMATION
Instructions to Provider: Provider MUST ensure that each peace officer in attendance is provided with a copy of this completed
form.
Instructions to Agencies: Agencies must ensure the ethics statement is signed by the officer attending distance learning courses.
Instructions to Attendees: Once provided a copy of this form, it shall be the Officer’s responsibility to complete the VERIFICATION
OF ATTENDANCE section of the form and deliver the form to their respective agency for inclusion in their training file. Do not send
this form to AZPOST. Arizona administrative rules require law enforcement agencies to maintain training records for any and all
peace officers they employ. This form meets AZPOST requirements for such record.
CONFIRMATION NUMBER ISSUE DATE
☐ Distance Learning
AGENCY SPONSORING TRAINING
☐
OUTSIDE PROVIDER OF TRAINING
☐ Continuing
☐
ATTESTMENT: This program as submitted meets the requirements of Arizona Administrative Code R13-4-111 and, therefore, may be
used to satisfy the certification retention requirements for the hours of training specified above.
VERIFICATION OF ATTENDANCE
NAME OF PEACE OFFICER (print)
Ethics Statement: I verify I met all reader established course attendance, participation, and testing requirements. I understand
dishonesty involving attendance or cheating during the course could result in disciplinary action against my Arizona Peace Officer
The above-named peace officer has attended training as specified and successfully completed any required testing. The course
followed the lesson plan and all requirements of R13-4-111 were met. All lesson plans and attendance rosters for this course are on
file at the location listed below. They are available to AZPOST for audit.
AZPOST / LAW ENFORCEMENT AGENCY
OUTSIDE PROVIDER / VENDOR
PRIMARY INSTRUCTOR / FACILITATOR NAME (Printed)
NAME OF PROVIDER – INSTRUCTOR NAME (printed)
☐ AZ POST ☐ AGENCY
SIGNATURE OF PERSON WHO APPROVED VENDOR PROVIDED TRAINING
LOCATION WHERE LESSON PLAN IS MAINTAINED (if not AZPOST)
LOCATION WHERE LESSON PLAN IS MAINTAINED (if not AZPOST)
TRAVEL REIMBURSEMENT REQUEST
☐
Preapproved AZPOST Travel Status Reimbursement Applicable _________
If reimbursement is requested, please forward a copy of this form to AZ POST along with documentation showing agency payment to
the individual named above. The request for reimbursement must be submitted within 60 days after completion of training. I
hereby certify that I am a duly authorized official of the claimant, that the claim is in all respects true, accurate, correct and has not
heretofore been paid and is in accordance with state law and AZ POST rules. The individual identified on this program approval has
attended this course of instruction as a sworn peace officer in the State of Arizona appointment by this agency. The agency
original documents covering records of employment, payrolls, receipts of travel, per diem, tuition and other expenses to substantiate
NAME / TITLE OF AUTHORIZED OFFICIAL (PRINT)
Building a Mental Armor w/Psychological/Emotional Training
Glendale Community College
Glendale Community College
Glendale Community College
Glendale Community College
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