New York State Division of Criminal Justice Services
Office of Public Safety/Security Guard Program
80 South Swan Street Albany, NY 12210
SECURITY GUARD TRAINING SCHOOL NOTIFICATION OF CHANGES
Complete Part I for changes to the school information and/or documents. Complete Part II for changes to the School
Owner, School Director, School Co-Director or Partner(s). Complete Parts I & II if there are changes to information
contained in both parts. Submit Part I and/or Part II to the Division of Criminal Justice Services at the above address.
Direct questions to Security Guard Program staff at (518) 457-4135.
PART I
School Name:
School Identification Number:
CHANGE(S) [Check all that apply and provide information]:
School Name: _________________________________________________________________________
*For any corporate, limited liability company or limited partnership provide copy of NYS Department of State name availability response.
School Phone Number: __________________________________________________________________
School Mailing Address: _________________________________________________________________
_________________________________________________________________
School E-Mail Address: __________________________________________________________________
Type of Ownership - Provide supporting documents for type of ownership.
Sole Proprietorship – Provide consent to do business from county clerk
Partnership/Limited Partnership – Provide copy of partnership/limited partnership agreement
Corporation – Provide Certificate of Incorporation and if applicable, certificate of assumed name
Limited Liability Company – Provide copy of Official Filing Receipt
Not-for-Profit – Provide Certificate of Incorporation
Other – Provide applicable documentation
School
Catalog (Attach copy)
Enrollment Agreement (Attach copy)
Payment Receipt Form (Attach copy)
Printed Name of Requester
Title (School Owner or School Director)
(School Owner or School Director only)
Signature of Requestor
Date
NEW YORK STATE DIVISION OF CRIMINAL JUSTICE SERVICES August 2011