quick navigation

Basic Peace Officer Training Academy Enrollment

 
Personal Information
First Name
Last Name
Middle Name
Maiden Name
Street Address
City
State
Zip Code
County
Telephone
E-Mail
Date of Birth
 
Male Female
Height (ex: 6'4") Weight lbs.
Eye Color Hair Color
Ohio Driver's License No. Exp. Date
Your driver's license is: Valid Suspended
Are you insured to operate a motor vehicle? Yes No
If no, you will be required to show proof of coverage prior to participating in driving.
Which police academy will you be attending? Day Evening
 
Place of Birth
City
County
State or Country
 
Ethnic Background
Caucasian African American Native American
Hispanic/Latino Asian/Pacific Islander Other
 
Education Background
High School Associate Degree Bachelor's Degree
Master's Degree Other Type
 
Employer Information
Name
Address
City
Zip Code
Employer Telephone
 
Agency Information
   
If you are being sponsored by an agency (not open enrollment), please provide the following information:
Appointing Agency
Address
City
State
Zip Code
County
Date of Appointment
Position/Title
 
By submitting this form, I certify that the above statements are true to the best of my knowledge. I will abide by the rules and regulations of Clark State Community College.
 

Admissions Office
Sara T. Landess Technology and Learning Center
937/328-6028
E-Mail Us

Greene Center
937/429-8819
E-Mail Us

Student Life