Free 46167.FH11 - Indiana

LAW ENFORCEMENT TRAINING ROSTER
State Form 46167 (R / 5-09) LAW ENFORCEMENT TRAINING BOARD / INDIANA LAW ENFORCEMENT ACADEMY

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Name of provider or instructor Location of training Title of course Check one Telephone number

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Name of contact person at training site Name of primary instructor

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Signature Dates of training (month, day, year)

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Printed name

Other ______________________________________________
Date (month, day, year) Course number Inservice credit (hours)

I affirm that the information contained herein is complete and accurate to the best of my knowledge.

Provider or instructor number

From PSID NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.

To LAST NAME FIRST NAME M.I. DEPARTMENT