SOUTH CAROLINA POLICE k-9 ASSOCIATION

SOUTH CAROLINA POLICE K-9 ASSOCIATION

Certifying Official Application

Date:                          

Last Name:                                                    First                                        MI:               

Address:                                                                                 City                                        

State:                          Zip:                              E-Mail:                                                         

Phone #: (H)                                       (C)                                           (P)                              

Date of Birth:                                                 SSN:                                                             

Law Enforcement Years:                   Years Working K9:                           

Years Instructing K-9:                                  

Certifications with K-9                                                                                                                                                                                                                             

AGENCY INFORMATION:

Agency:                                                          Address:                                                        

City:                                                                State:                          Zip:                             

Supervisor:                                                     Phone #:                                                         

Check One:

             I have a minimum of four (4) years experience in handling and /or training canines in the area of                                                                     .

                                                (Obedience and / or Patrol and / or Scent Detection)

My signature below certifies that the above information is true to the best of my knowledge.

Applicants Signature:                                                            Date:                                      

Print Name:                                                                           

Sponsoring Executive Committee Members Signature:                                                    

Mail Applications to: SCPK9A P.O. Box 1514 Irmo, South Carolina 29063

Send mail to  timnk9bertus@aol.com  with questions or comments about this web site.

Last modified: 05/30/07