Apply for Wait list Enrollment

Peer Support for Law Enforcement
Monday, October 26 - Thursday, October 29, 2020
8:00am - 5:00 pm
Location: Conyers Police Department
Directions: 1194 Scott Street, Conyers, GA 30012

Great FREE Training from ACHIDTA, Conyers PD and the RCTA

Back by Popular Demand

 

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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 Name: *

Indicate your agency type *
Federal State Local
Military Other (Not Law Enforcement)

AGENCY ADDRESS
Address 1:*

Address 2:

City: *

State:* 
  Zip code:

CONTACT INFORMATION
(for registration purposes only) * required
Best Contact Phone # (include area code) *

Cell Phone: (include area code)

E-mail: *
  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)


 

 Credentials Required at Registration