IDC/Facilitator Development Course Registration Application
Complete & electronically sign form

For more information on the Center for Policing Excellence, please visit our website at: http://www.oregon.gov/DPSST/CPE/pages/index.aspx

Course Title & Location
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Course Date(s)
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DPSST # (required for certified personnel)
Your answer
Rank/Title
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Discipline
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Student Name
Your answer
Work Email (notice of confirmation will be sent to this address)
Your answer
Employing Agency
Your answer
Agency Mailing Address
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Office Phone (w/extension)
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Work Cell Phone
Your answer
Supervisor's signature authorizing participation IS REQUIRED
By (electronically) signing below, I affirm that the applicant(s) listed on this registration application and any attached sheet(s) is/are approved by me to attend the training listed above.
Supervisor's Electronic Signature (print full name)
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Supervisor's Rank/Title
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Date
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Submit
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