Interest 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 to show interest only. Upon submittal of this form, you will be contacted to share more information and enroll.

First Name: *

Last Name: *

Phone: *

Email: *

Street Address: *

City: *

State: *

Zip Code: *

Are you currently employed? *

If yes, where are you employed?

Do you hold a valid driver’s license? *

Are you a US citizen? *

Are you a military Veteran, Reserve or Guard? *

What month would you like to attend the program?

Questions? Contact Us!

Wolf Graf

Commander, Basic Peace Officer Training Academy
937-328-5728
Email

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