Date (month, day, year) Name of Course Location Number of ...
INSTRUCTOR HOURS LOG
State Form 55222 (R / 7-13)
INSTRUCTIONS: Use this form to record ILEA instructor hours for certification and recertification.
Public Safety Identification number (PSID)
E-mail address
Date (month, day, year)
Name of Course
Location
INDIANA LAW ENFORCEMENT ACADEMY 5402 Sugar Grove Road P.O. Box 313 Plainfield, IN 46168
Number of Students Number of hours
Signature
Printed name
Total
Total Date (month, day, year)
................
................
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