APPLICANT * required
Enter name as it will appear on certificate
of completion. Do not use all caps.
First Name *
Last Name *
Position/Title/Rank *
AGENCY / ORGANIZATION
Agency/Organization:
If you agency does not appear on the above list
select - Other - above and fill in the
Full Agency Name below:
Other Agency/Organization Name:
Indicate your agency type *
Federal State Local
Military Other (Not Law Enforcement)
AGENCY ADDRESS
Address 1:*
Address 2:
City: *
CONTACT INFORMATION
(for registration purposes only) * required
Best Contact Phone # (include area code) *
Cell Phone: (include area code)
E-mail: *
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SUPERVISOR INFORMATION
For Law Enforcement Status Verification
Name of Approving Supervisor: *required
Phone Work: (include area code)
E-mail:
HIDTA TASKFORCE MEMBER
Yes No
IDENTIFYING INFORMATION
Sworn GA Law Enforcement Officers (for GA POST credit)
Okey #*
(enter N/A if you are not a Georgia Officer)
Sworn Law Enforcement Officer
Crime / Intelligence Analyst
Other
(please provide details)
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