Basic Police Officer Inquiry form

Completion of this form does not automatically enroll you in the Clark State Basic Peace Officer Training Academy or Clark State College. It is for informational purposes only. Upon submittal of this form, you will be contacted by the Academy Commander. To complete enrollment, call 937.328.7960.

Name *

Street Address *

City *

State *

Zip Code *

Phone Number *

E-Mail

Date of Birth (MM/DD/YYYY) *

Gender *

Yes, I agree to the provided terms.