Connecticut Police Academy Police Officer Standards & Training Council

Effective Date: Sep 1, 2016 Rev. March 2017 DEPARTMENT OF EMERGENCY SERVICES & PUBLIC PROTECTION CONNECTICUT POLICE ACADEMY POLICE OFFICER STANDARDS & TRAINING COUNCIL

COURSE REGISTRATION FORM

ONE FORM PER APPLICANT

AUTHORIZED OFFICIAL______(PLEASE PRINT)

AGENCY______

TELEPHONE______EMAIL______

SIGNATURE______

**I HAVE ADVISED STAFF OF APPROPRIATE DRESS CODE FOR THIS COURSE.

Title of Course______

Location of Course______

Dates of Course______

Applicant Name:______Rank:______

POST I.D. #:______ADMIT______DENY______

Prerequisite Information______Refer to course announcement for information

Attention POST Staff (circle one): COON FULLENWILEY

Mail or Fax to: Questions: Field Services Training Division Curriculum Manager, Timothy Coon Connecticut Police Academy [email protected] 203-427-2625 Police Officer Standards & Training Council 285 Preston Avenue Secretary, Barbara Fullenwiley Meriden, CT 06450-4891 [email protected] 203-427-2622

(203) 238-6119 Field Services FAX (203) 238-6643 Agency FAX

BILLING INFORMATION TO BE COMPLETED BY APPLICANT TUITION (PER APPLICANT) CHIEF OF POLICE OR COMMANDING OFFICER OF AGENCY: TO BE COMPLETED BY APPLICANT ______$75 _____ 1 day or less AGENCY:______$200 _____ 2-5 days ADDRESS:______$300 _____ 6-10 days CITY:______STATE:______ZIP:______No tuition required:______TELEPHONE #:______

P.O.# (if applicable):______