WESTCHESTER COUNTY
 DEPARTMENT OF PUBLIC SAFETY
POLICE ACADEMY TRAINING COURSE
 REGISTRATION FORM

Submitting this request does NOT guarantee that you are registered for the course
requested. Your registration will be confirmed by our staff  via e-mail or phone or
confirmation letter.

Please provide us with the following valid contact information:

If your agency doesn't appear in the list below, please specify what agency you 
belong to in the "other" box.

Please be sure to include a valid e-mail address in order to receive
              class confirmation!
 Training Courses are only available to  members of Police, Fire and
              EMS agencies. 
 All requests are subject to confirmation by academy staff.


* Required fields!

 

*Agency:

 

OTHER (if not listed)

                      Please list address if not on above list of agencies

AGENCY ADDRESS:

 

*REQUESTED BY: 

 

*PHONE#: 

 

*E-mail Address: 

 

*COURSE TITLE:

 

OTHER (if not listed)

 

Student Name#1: Rank/Title#1:  
Student Name#2: Rank/Title#2:  
Student Name#3: Rank/Title#3:  
Student Name#4: Rank/Title#4:    
Student Name#5:  Rank/Title#5:  

 

Please add any additional comments or explanation below:

 

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