Waterways Conservation Officer Trainee Form
Commonwealth of Pennsylvania
WATERWAYS CONSERVATION OFFICER TRAINEE (60002)
ENROLLMENT IN ACT 120 BASIC TRAINING PROGRAM
VERIFICATION FORM
SECTION A (TO BE COMPLETED BY CANDIDATE):
You must currently be enrolled in the Municipal Police Officers’ Education and Training Commission Certified Basic Police Academy (Act 120) training with a graduation date no later than September 16, 2020.
_________________________________________________ _____________________________________
Name Email Address
__________________________________________________
Anticipated Date of Graduation
_____________________________________________ ________________________________
Signature Date
SECTION B (TO BE COMPLETED BY SCHOOL/ACADEMY/TRAINING FACILITY): A designated official (Registrar, Public Safety Director, Academy Director, etc.) must complete Section B.
We verify that the above candidate is currently enrolled in the Municipal Police Officers’ Education and Training Commission Certified Basic Police Academy (Act 120) training, meets the requirements for participation in this training, and is scheduled to graduate on the above date.
________________________________________ _____________________________________________
Name of Authorized Representative Electronic Signature of Authorized Representative
________________________________________ _____________________________________________
Title Date
________________________________________ ( )_________________________________________
School/Academy/Training Facility Name Telephone Number (include area code)
________________________________________ _____________________________________________
Street Address Email Address
___________________________ __________________________ ____________________________
City State Zip Code
After the Authorized Representative completes Section B, the candidate must submit this form with their application.
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