application for course certification

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1、FormALLI569-0000(10/00)IllinoisLawEnforcementTrainingandStandardsBoard4500South6thStRoad,Rm173●Springfield,Illinois62703-6177●Telephone:(217)782-4540ApplicationforCourseCertification1.Agencysubmittingrequest:2.NameofCourseDirector:3.PhoneNumber:Addres

2、s:___________________________________________________________5.Addresswherecoursewillbepresented:_________________________________4.CourseTitle:6.Coursepresentationdates:7.NumberofOfferingsandDates:Startingdate_____Time_____EndingDate_____&Hour_____8.

3、CourseLength:9.Format:_____hoursperday10.SplitSession:HoursinCourse:___________daysperweek_____weeks_____Yes_____No11.Participatinglawenforcementagenciesandestimatednumberoftraineesfromeachagency:_____12.Isadditionaltravelrequiredotherthantocoursesite

4、?13.Minimumnumberoftrainees_________Yes_____NoIfyes,enternumberofmilesfromcoursesite:_____milesMaximumnumberoftrainees____14.Resident___15.LivingAccommodations:OnCampus___16.Cost:TuitionCommuter___Commercial___NotApplicable___Meals_____Resident_______

5、____________________________________________________17.Facilities-Numberandsizeofclassrooms:Lodging_____Commuter___________________________________________________________Other_____Regional18.Totalseatingcapacity:_____Commuter_____19.Courseobjectivesa

6、ndnarrativedescriptionofcourse(useadditionalsheetsofpaperifnecessary)Isthiscoursecopyrightedorlicenseprotected?Yes/NoIfyes,thencompleteFormX20.Methodofpresentation(indicatealltechniquesused)21.Numberofinstructors:Lecture____Demonstration____Simulation

7、____RolePlaying____Conference____Other____22.Trainingaidesused:23.Testandreferencematerial:24.Methodofevaluatingstatedobjectives:25.Icertifythattheinformationcontainedhereinistrueandcompletetothebestofmyknowledge.Iauthorizeinvestigationofallfactsconta

8、inedinthisApplicationandagreetoprovideanyadditionalinformationasmayberequiredbytheBoard.IunderstandthatfalseormisleadinginformationgiveninthisApplicationorinterview/smayresultinimmediatedecertificationofthiscourseand/oranycourseofferedbytheApp