School Safety Coordinator Reg Form - Arkansas Center for School Safety Arkansas Center for School Safety

Course Name *

Course Date *

Course Location *

Rank/Title/Position *

First Name *

Middle Initial (if you have no middle initial, enter NMI) *

Last Name *

Nickname/Preferred Name

Email *

Would you like training schedule notifications emails sent to you?

CLEST-ID Number (Required for Arkansas Commission on Law Enforcement Standards & Training (CLEST) reporting if you are Arkansas LE.)

Phone *

Alternate/Evening Phone Number

Employer *

Employer Address *

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Employer Phone/Extension

Employer Fax

Are you Sworn or Non-Sworn? *

Position Type (Select all that apply) *

If you selected other, What is your position?

Email

This field is for validation purposes and should be left unchanged.