Pennsylvania Commission on Crime and Delinquency

CONSTABLES’ EDUCATION AND TRAINING BOARD

Training Enrollment Form

FIREARMs TRAINING

Please Note: Print completed form, sign and date it, and FAX or mail directly to the appropriate training delivery contractor. Do not send or fax to PCCD. If you have never successfully completed Act 44 Basic Firearms Training, you must enroll in the 40-hour Basic Firearms Training.

40-Hour basic firearms TRaining (Class ID ends in “B”)

FIRST choice class id number: /

B

location:
second choice class id number: /

B

location:

20-Hour annual firearms training (Class ID ends in “A”)

FIRST first choice class id number: /

a

location:
second choice class id number: /

a

location:

20-Hour advanced firearms training (Class ID ends in “S”)

FIRST choice class id number: /

S

location:
second choice class id number: /

S

location:
Name:
Last / First / MI
Certification Number:
MAILING ADDRESS:
Check here if new address
Business Telephone Number:

Check here if new telephone number

business fax number:

Check here if new FAX number

PCCD Firearms Enrollment Form (REV 05/2011) Page 1 of 2

PENNSYLVANIA COMMISSION ON CRIME AND DELINQUENCY

CONSTABLES’ EDUCATION AND TRAINING BOARD

Handgun Registration

for

Firearms Training

Please provide the following information for the PRIMARY handgun that you will use to practice and qualify with at the training session for which you have registered. This must be the handgun that you will generally carry when you are conducting your duties as a Constable. This firearm must be owned by and registered to you. You may also provide this information for a SECONDARY handgun. This is entirely optional. The second handgun must also be owned by and registered to you. You must provide a properly fitting, secure holster for every firearm you use and you must provide factory new ammunition for each attempt at qualification.

primary handgun

/

secondary gun

Make (Brand)
Caliber
Serial Number
Model (Name or Number)
Semi-Auto/Revolver

APPLICANT’S UNDERSTANDING AND SIGNATURE

I am, as of this date, a Certified Constable or Deputy Constable and eligible to take this training. Further, I will inform the training school of any changes in my status as a constable or deputy constable that may occur between now and the conclusion of the training program for which I am now registering. By signing my name below, I am stating that the information given on this registration form and the above affirmation is true and correct to the best of my knowledge.

Signature of Applicant

/

Date

FireReg-GunReg Form (REV 12/2008) Page 2 of 2