In-Service Law Enforcement Pre-Registration Form – March – May Form > In-Service Law Enforcement Pre-Registration Form – March – May Last 4 digits of Social Security Number(Required)First Name(Required)Middle InitialLast Name(Required)Home Address(Required)City(Required)State(Required)Zip(Required)County(Required)Date of Birth(Required) Phone Number (Day)(Required)Phone Number (Night)(Required)E-mail Address(Required) Highest Grade Completed(Required)– Select –1234567891011121314151617NC Resident(Required) Yes No Gender(Required)– Select –FemaleMaleEmployment Status(Required)– Select –Employed Full-TimeEmployed Part-TimeSelf EmployedRetiredRace(Required)– Select –White Non-Hispanic OrginBlack Non Hispanic OrginHispanicAmerican IndianAsian or Pacfic IslanderAlaskkan NativeAgencies you are a member of(Required)– Select –Law EnforcementEMSFireRescueAgency Name (Agency Currently Holding your Certification)(Required)Agency Address(Required)Job Title and/or Rank:(Required)MANDATED In-Service Topics Include:(Required) None 2026 Online Legal Update – 4 Credits 2026 Online Legislative Update – 2 Credits 2026 Online Firearms Training & Qualification – 4/2 credits 2026 Online Youth-Focused: Strategies & Responses – 2 credits 2026 Online Armed/Unarmed Security – 2 credits 2026 Online Committed to Integrity – 2 credits 2026 Online Critical Decision-Making Model – 2 credits 2026 Online Illegal Business Activity – 4 credits Total Mandated Hours available: 22/2OPTIONAL In-Service Topics Include(Required) None 2026 Online DWI – Arrest to Conviction – 4 Credits 2026 Online Hazardous Materials (Haz-Mat) – 2 Credits 2026 Bloodborne Pathogens – 2 Credits Total Topics of Choice Hours: 10Terms of Agreement(Required) I agree By checking this box I do hereby attest that the information contained within the online registration form to be accurate and that my position places me within NCAC .203(5) (A) or (C) for fee exemption. I also In consideration for the opportunity to participate in the Southwestern Community College training program of the undersigned participant agrees to comply with all rules, regulations, procedures and safety precautions established by Southwestern Community College in connection with the above-referenced training program and the use of the equipment and facilities associated with it. Furthermore, I acknowledge the existence of the risk connected with this program, agree to assume such risks and agree to accept responsibility for any injuries, illness, death, and property damage sustained by me in the course of participating in this program. I hereby agree for myself, my heirs, assigns, executors and administrators to release and consent not to sue Southwestern Community College, its employees, whether full or part-time, paid or unpaid, it administrators directors and agents, for any death, property damage or loss, which I may sustain as a direct or indirect result of participation in the above referenced training program.
