<p> Effective Date: Sep 1, 2016 Rev. March 2017 DEPARTMENT OF EMERGENCY SERVICES & PUBLIC PROTECTION CONNECTICUT POLICE ACADEMY POLICE OFFICER STANDARDS & TRAINING COUNCIL</p><p>COURSE REGISTRATION FORM</p><p>ONE FORM PER APPLICANT </p><p>AUTHORIZED OFFICIAL______(PLEASE PRINT)</p><p>AGENCY______</p><p>TELEPHONE______EMAIL______</p><p>SIGNATURE______</p><p>**I HAVE ADVISED STAFF OF APPROPRIATE DRESS CODE FOR THIS COURSE. </p><p>Title of Course______</p><p>Location of Course______</p><p>Dates of Course______</p><p>Applicant Name:______Rank:______</p><p>POST I.D. #:______ADMIT______DENY______</p><p>Prerequisite Information______Refer to course announcement for information</p><p>Attention POST Staff (circle one): COON FULLENWILEY </p><p>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</p><p>(203) 238-6119 Field Services FAX (203) 238-6643 Agency FAX </p><p>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><p>P.O.# (if applicable):______</p>