Form Chl-100 - License To Carry A Handgun Proficiency Course Certificate Of Training

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For DPS Use Only
Texas Department of Public Safety
Regulatory Services Division
To upload CHL-100 please visit RSD secured website:
https://
LICENSE TO CARRY A HANDGUN PROFICIENCY COURSE
CERTIFICATE OF TRAINING
STUDENT INFORMATION
Last Name
First Name
Middle Initial
Driver License
Issuing State
ID
Issuing State
Number:
(2- letter code)
Number:
(2- letter code)
CLASSROOM TRAINING
Laws That Relate to Weapons / Use of Force
Hr
Min
Safe Storage
Hr
Min
Non-Violent Dispute Resolution
Hr
Min
Handgun Use and Safety
Hr
Min
(Including use of restraint holsters)
Total Classroom Time:
Hr
Min
My signature verifies the above named individual has received a minimum of 4 hours classroom instruction and successfully
passed the required written test for a Texas License to Carry a Handgun.
LTC Instructor Name (printed)
Instructor #
LTC Instructor Signature
Completion Date
(MM/DD/YYYY)
PROFICIENCY DEMONSTRATION
Name of Range (if any)
LTC Instructor renewal
Address
City
State
Zip Code
TX
My signature verifies the above named individual has successfully demonstrated proficiency using the required course of fire for
a Texas License to Carry a Handgun.
LTC Instructor Name (printed)
Instructor #
LTC Instructor Signature
Completion Date
(MM/DD/YYYY)
STUDENT CERTIFICATION
I verify that the information provided is true and correct. I also understand this is an official Government record and any missing
information and/or false statement made on this document may result in criminal prosecution.
Student Name (printed)
Student Signature
Date
(MM/DD/YYYY)
CHL-100 (Rev. 03/2017)

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