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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