Library Course Registration - Arkansas Criminal Justice Institute Arkansas Criminal Justice Institute

Course Name *

Course Date *

Rank/Title/Position *

First Name *

Middle Initial (if you have no middle initial, enter NMI) *

Last Name *

Nickname/Preferred Name

Email *

Would you like training schedule notifications emails sent to you?

Yes
No

CLEST-ID Number (Required for Arkansas Commission on Law Enforcement Standards & Training (CLEST) reporting if you are Arkansas LE.)

Are you a School Nurse? *

Yes
No

Nursing License number

School District Name

School Name

Gender *

Male
Female

Ethnicity *

Hispanic/Latino/Spanish Origin
Non-Hispanic/Non-Latino/Not of Spanish Origin

Race *

American Indian or Alaska Native
Black or African/American
White
Asian
Native Hawaiian or Other Pacific Islander
Multiracial
Other

Phone *

Alternate/Evening Phone Number

Employer *

Employer Address *

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Employer County *

Employer Phone/Extension *

Employer Fax

Are you Sworn or Non-Sworn? *

Sworn
Non-Sworn

Are you currently CPR certified? *

Yes
No

Position Type (Select all that apply) *

If you selected other, What is your position?

How did you hear about this class?

Internet Search
Email
Fax
Facebook
Twitter
Policetraining.net
Referral
Other

If you selected "Other" above, how did you hear about this class?

LAW ENFORCEMENT/CORRECTIONS PERSONNEL ONLY. Please complete the following information. (THESE ARE NOT REQUIRED)

Training Officer's Rank First Last Name

Training Officer's Phone Number/Extension

Training Officer's Email Address

How many sworn officers are in your agency?

10 or less
11-20
21-50
51-99
100-249
250 or more
Does not apply

Population Served

1 - 2,500
2,501 - 10,000
10,001 - 25,000
25,001 - 50,000
50,001 - 75,000
75,001 - 100,000
100,001 - 500,000
500,001 or more
Does not apply

Type of Agency

Local
State
County
Federal

Phone

This field is for validation purposes and should be left unchanged.