STUDENT INFORMATION * Required First Name:* Last Name:* Middle Name:*
YOUR AGENCY / ORGANIZATION NAME*
Position/Title/Rank:* Permanent Address: (no P.O. Boxes)* Address 2 City:*
State:*
Zip Code:*
CONTACT INFORMATION Phone Work: (include area code)* Cell Phone: (include area code) E-mail:* (Please Use Law Enforcement Agency Email Address) IDENTIFYING INFORMATION * Sworn Law Enforcement Officer Hispanic Non Hispanic / Latino Post ID#: Date of Birth (mm/dd/yy):* (For College Credit)
Age:*
Birth City:*
Birth State or Country:* Gender* Male Female
Previous Last Name (enter N/A if the same):*
HIGH SCHOOL LAST ATTENDED* Name of High School* County (if California)* State or County (If NOT California)* Years Attended* - Year Graduated* High School Graduation Status* Received HS Diploma Not HS Graduated or Student GED Equivalency Proficiency Exam Foreign Diploma Concurrently Enrolled Adult School Select
WHEN DID YOUR PRESENT STAY IN CALIFORNIA BEGIN?*
Approximate date you arrived in California (mm/dd/yy)*
PRICE: $450
Members and Non Members
Law Enforcement Credentials Are Required at Registration