Missouri Sheriffs' CLEE Instructor Record
Instructor Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
County
*
Where you live.
Daytime Phone
*
Please enter a valid phone number.
Cell Phone
Please enter a valid phone number.
Instructor Email
*
example@example.com
Instructors Peace Officer License #
Certification Expiration Date
-
Month
-
Day
Year
Examples:(firearms instructor certificate expiration date, taser instructor certificate expiration date, OC instructor expiration date.)
Name of Course to be Taught
*
Describe what qualifies this person to instructor this course.
*
Upload and training certificates, certifications, licenses, etc. related to the topic to be taught.
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Person submitting the form
*
First Name
Last Name
Email - Person submitting the form
*
example@example.com
Signature of Person Submiting
*
OFFICIAL USE ONLY
____________________________________________________________________________________________________
Notes
Status
Reviewed By
MSA Use Only
Date
-
Month
-
Day
Year
Date
Class Post control #
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