Corrections Officer Academy Registration Form APPLICANT INFORMATIONLCOTS#(Required)SSN (last 4 digits)(Required)Name(Required) First Last Previous Last Name(s)Please list any previous last names (maiden, married, etc. — optional)Home Address(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Applicant Email Address(Required) Birthdate(Required)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender(Required) Male Female Are you being sponsored by an agency?(Required) Yes No DEPARTMENT INFORMATIONDepartment(Required)Department Email Address(Required) Department Training Authorized By(Required)ACADEMY COSTWhich academy session would you like to attend?(Required) September 2-26, 2025 February 2-27, 2026 September 8 – October 2, 2026 February 1-26, 2027 Corrections Officer Academy (WFD26007) Price: Total PAYMENTHow will you be making payment — mailing a check or contacting Student Financial Services with credit card information?Payment Method(Required) Check Credit Card
