Law Enforcement Training Roster Form
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LAW ENFORCEMENT TRAINING ROSTER
State Form 46167 (R / 5-09)
LAW ENFORCEMENT TRAINING BOARD / INDIANA LAW ENFORCEMENT ACADEMY
Please type or print clearly.
Name of provider or instructor
Telephone number
(
)
Location of training
Name of contact person at training site
Title of course
Name of primary instructor
Check one
Successfully completed
Incomplete
Failed
Other ______________________________________________
I affirm that the information contained herein is complete and accurate to the best of my knowledge.
Signature
Printed name
Date (month, day, year)
Dates of training (month, day, year)
Provider or instructor number
Course number
Inservice credit (hours)
From
To
PSID NUMBER
LAST NAME
FIRST NAME
M.I.
DEPARTMENT
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Parent category: Business