Basic Law Enforcement Training (BLET) Program Interest Form

Please complete this form which will be submitted to the program director.

Name(Required)

First Middle Last

Date of Birth(Required)

Age(Required)

Please enter a number from 16 to 99.

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

Email(Required)

High School Attended(Required)

Graduated High School?(Required)

College Attended/Major

Graduated College?

List any Military Service and Dischage Status

Do you have prior Law Enforcement experience, if yes, list the agency or agencies you have been employed with:(Required)

Have you ever lived or attended school outside of North Carolina since the age of 16?(Required)

If yes, please provide the name of the school.

I am interested in the following BLET class at Davidson-Davie Community College(Required)

How did you hear about this class?(Required)