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Act 551 and 622, 2021 SRO Information Form
Academic School Year 2021-2022
Note: If a field does not apply, enter "Not Applicable"
School District/Open Enrollment Charter School Information
School District/Open Enrollment Charter School Name?
(Required)
Name of the Person Completing This Form? (The person whom we can contact if needed about this submission.)
(Required)
School Resource Officer (SRO) Information:
Please complete this section for EACH SRO.
A SRO is a sworn, nonsupervisory, law enforcement professional and assigned to a public school campus during the instructional day or employed by a public school district. If a law enforcement officer in a school supervises SROs and also performs any of the functions of a SRO, that officer must be identified as a SRO and fulfill all training requirements. A law enforcement officer who is assigned to a public school for only extracurricular activities is exempt from the SRO training requirements.
SRO First Name?
SRO Middle Initial?
SRO Last Name?
SRO Last Name Suffix?
Law Enforcement Agency?
Email Address?
Phone Number?
Date When SRO Assigned To School?
MM slash DD slash YYYY
School Campus where SRO is Assigned? (Check all that apply)
Elementary
Middle School
JR High School
High School
Date of Youth Mental Health First Aid (YMHFA) Course Completion?
MM slash DD slash YYYY
Please upload a copy of the YMHFA Certificate of Completion form here.
Max. file size: 50 MB.
Date of 40-Hour SRO Basic Course Completion?
MM slash DD slash YYYY
Please upload a copy of the SRO Basic Course Certificate of Completion form here.
Max. file size: 50 MB.
Principal's Name?
Principal's School Campus?
Principal's Email Address?
Principal's Phone Number?
School Personnel Directly Responsible for Supervision of SRO Name? (if different than the superintendent or principal listed above)
School Personnel Directly Responsible for Supervision of SRO School Campus?
School Personnel Directly Responsible for Supervision of SRO Email Address?
School Personnel Directly Responsible for Supervision of SRO Phone Number?
End of SRO section. Repeat for EACH SRO.
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