AOMP

A. General Information

To be eligible, the applicant must be a full-time law enforcement officer on active duty in a municipal county, state, or federal unity of government or a college or university campus police officer. The applicant must have a high school diploma or equivalent. Some post-secondary educational experience is highly desirable, and official transcripts from colleges attended must accompany the application or be forwarded to the Program Director. Preferences will be given to applicants holding command, supervisory, or administrative positions in their departments. North Carolina State University is an equal opportunity institution.
All applicants and related correspondence should be either be submitted via the web or mailed/faxed to:
Program Director
Administrative Officers Management Program
401 Oberlin Road, Suite 225
Raleigh, NC 27605
FAX: (919) 513-4338

B. Endorsement by Applicant's Department
(required for admission to the program)

I hereby approve this application for admission to the Administrative Officers Management Program. If the applicant is selected to attend the program, he/she will be:

Assigned to the Administrative Officers Management Program at North Carolina State University for full-time study.
Granted a leave of absence or equivalent temporary status covering the period of the course during which his/her regular salary will be continued, and
Returned to active service upon completion of the program.

Supervisor Information

Name		Name of Supervisor
Signature		Signature NOT required if submitting application via web
Title
Phone
Department
Date

C. Certification of Applicant
(required for admission to the program)

I hereby apply for admission as a representative of my department to the Administrative Officers Management Program at North Carolina State University. If accepted as a student, I agree to devote to full-time study. I certify that I will return to active duty in my department upon completion of this course. I also certify that the information given in this application is
true and correct.

Name of Applicant
Signature of Applicant		Signature NOT required if submitting application via web

D. Application Information
(all fields required for admission to the program)

For which session are you applying?

Summer 2007 (May 9 - July 26)	Fall 2007 (Aug 29 - Nov 16)	Spring 2008 (Jan 23 - April. 11)
Summer 2008 (May 7 - July 14)	Fall 2008 (Aug 27- Nov 14)	Other (please specify)

Applicant Name (First, MI, Last)
For NCSU Registration Confirmation (SS# and DOB are protected)
Last 4 Digits Social Security Number		Year of Birth
Present Rank
Date of Rank
Department
Department Phone
Dept. Address
City
State		Zip Code
Home Address
City
State		Zip Code
Home Phone
Email
Joined Present Dept. in
Total years active law enforcement service
Present assignment duties:
In case of emergency, contact
Phone

What post-secondary schools or colleges have you attended?
(Please provide a transcript of college or university credit with application, copies are acceptable.)

Name of School/College
Dates Attended
Years Completed
Diploma or Degree Earned

Name of School/College
Dates Attended
Years Completed
Diploma or Degree Earned

Name of School/College
Dates Attended
Years Completed
Diploma or Degree Earned
How many undergraduate college credit hours do you have to date?
Are you currently enrolled in a degree program?		Yes No
If yes, at which institution?
And in what major?
How did you hear about AOMP?

Written Statement
Please mail, fax or e-mail us a written statement of why you are interested in attending the AOMP and any expectations from the program you may have, (300-500 words).
Fax: (919 )513-4338 or Email: jstrinks@social.chass.ncsu.edu

The following information is required for room assignments:
Do you need AOMP to arrange for room and board? (NCSHP dormitory)		Yes No
Gender:	Male Female
Are you a smoker?	Yes No

The following information is required for invoicing purposes:
Please indicate in the space provided below whose attention the invoice should be made & mailing address (an invoice will be mailed after the session begins, if you would like to prepay for your session, please call):

	or
Note: Resetting application will erase all information thus provided

If you have any questions please contact Julie Trinks at (919) 515-5149 or via email at jstrinks@social.chass.ncsu.edu.