Law Enforcement Training Course Request | Arkansas Tech University

Rank/Title/Position*

Name*

Email Address*

Phone Number*

Agency/Employer*

Agency/ Employer Address*

Agency/ Employer Phone Number*

Agency/Employer Fax Number

Course Requesting*

If other, please specify and describe

Preferred Course Location

ATU Russellville Campus

ATU Ozark Campus

Requester Agency

Estimated Class Size*

Please list three date and time options for the requested course*

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