SRO Certificate Application Form

Rank/Title * Required
First Name * Required
Middle Initial (if you have no middle initial, enter NMI) * Required
Last Name * Required
Preferred Certificate Name * Required
Email Address * Required
CLEST-ID Number (Required for Arkansas Commission on Law Enforcement Standards & Training (CLEST) reporting if you are Arkansas LE.) * Required
Date of Birth * Required
MM slash DD slash YYYY
Cell Phone Number
Alternate/Evening Phone Number
Agency/Department * Required
Agency Address * Required
Agency City, State, Zip * Required
Agency Phone Number/Extension * Required
Agency Fax Number
Certificate Applying For: * Required
- Level I Basic Certificate
- Level II Intermediate Certificate (must have Basic Certificate)
- Level III Advanced Certificate (must have Intermediate Certificate)
- Level IV Senior Certificate (must have Advanced Certificate)
Mailing address to send certificate to. (address, city, state, zip) * Required
Name of Current School or Former Assigned School * Required
Dates of Employment * Required
Number of Years worked as SRO? * Required
Supporting documents
Please send any supporting documents i.e. Certificates for any required training not taken at CJI, letters of support, college transcripts etc. to Keith Graham at kegraham@cji.edu.
Date Submitted * Required
MM slash DD slash YYYY
Electronic Signature * Required
I hereby attest that to the best of my knowledge the information on this form is true and correct.