Intent to Enroll Form

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Certiﬁ cate and Degree Program Partnerships Intent To Enroll Form Date: Agency: Last Name: First Name: MI: Address: Phone: E-mail: Intended Program of Study: (Please check one.) Crime Scene Investigation Law Enforcement Administration Education Level: (Please check one.) High School Some college, no degree Associate’s Bachelor’s Master’s or above Partnering Institution of Higher Education: (Check the school you plan to attend.) Arkansas State University at Beebe Ozarka College Arkansas State University at Heber Springs Phillips Community College of the UA Arkansas State University at Jonesboro South Arkansas Community College Arkansas State University at Mountain Home Southeast Arkansas College Arkansas State University at Newport University of Arkansas at Fort Smith Black River Technical College University of Arkansas at Little Rock College of the Ouachitas* University of Arkansas at Monticello Cossatot Community College of the UA** University of Arkansas at Pine Bluff National Park College University of Central Arkansas North Arkansas College UA Community College at Batesville Northwest Arkansas Community College UA Community College at Hope UA Community College at Morrilton * Does not offer Technical Certificates in either program ** Only offers Law Enforcement Administration program Have you completed any college-level courses? Yes No If yes, name of college or university where completed: Are you a certified law enforcement officer? Yes No Please submit a copy of your certification with this form If you are not a sworn law enforcement officer, are you working as a crime scene investigator? Yes No I authorize the Criminal Justice Institute to release this form to the colleges/universities I have selected. A representative from the selected colleges/universities may contact me regarding the program. Signature: Date: Submit completed form and a copy of your law enforcement certification to Bridgette McInroe at [email protected] or 501-565-3081 (fax). Submission of this form does not obligate you to complete the selected program of study..

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