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STUDENT INFORMATION
*
Required
First Name:
*
Last Name:
*
Middle
Name:
Position/Title/Rank:*
YOUR AGENCY/ORGANIZATION NAME: *
Work
Address*
Address
2
City:*
State:* (2 characters)
Zip Code:*
CONTACT INFORMATION
Work Phone: (include area code)*
Cell
Phone: (include area code)
Email Address:*
Law Enforcement Agency Email
Address Required
IDENTIFYING INFORMATION*
Post ID#:
Date of Birth:*
Gender* Male Female
Previous
Last Name (enter N/A if the same):
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HIGH SCHOOL LAST ATTENDED* Name of High School*
County*
State (or Country if outside U.S.)*
Years Attended: *
From:
To:
Year Graduated: *
High School Graduation Status*
WHEN DID YOUR PRESENT STAY IN CALIFORNIA BEGIN?* Approximate date you arrived in California?
Enter birth date if always in CA*
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