STUDENT INFORMATION  *  Required
First Name: *

Last Name: *

Middle Name:
 
Position/Title/Rank:*

YOUR AGENCY/ORGANIZATION NAME: *
Work Address*
 
Address 2
 
City:*

CONTACT INFORMATION
Work Phone: (include area code)*


Cell Phone: (include area code)
 
 
E-mail:*
 
(Please Use Law Enforcement Agency Email Address)

IDENTIFYING INFORMATION*
Post ID#:   

Date of Birth (mm/dd/yy):*
 
Gender* Male Female

Previous Last Name (enter N/A if the same):   
                                                                                                                        

HIGH SCHOOL LAST ATTENDED*

Name of High School*
 
County*
 
State (or Country if outside U.S.)*
 
Years Attended*
 -  
Year Graduated*
 

High School Graduation Status*
Received HS Diploma Not HS Graduated or Student GED Equivalency Proficiency Exam Foreign Diploma Concurrently Enrolled Adult School Select  

WHEN DID YOUR PRESENT STAY IN CALIFORNIA BEGIN?*