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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