Brazoria County Sheriff’s Employees only Form for Registration of Classes

 

Student Name: _______________________________________________________

(Please Print)         Last                                             First                                                                   M.I.

Social Security Number: ___________________________ D. O. B. ___________

 

Check one of the boxes Below:

_______ Peace Officer __________ Jailer _________ Civilian __________ Other

 

Division you work in: _____________________________________________________

Supervisor: _____________________________________________________________

Course Title Date(s) Times

1. ______________________________________________________________________

2. ______________________________________________________________________

3. ______________________________________________________________________

4. ______________________________________________________________________

 

____________________________________________ Date: _________________________

Signature of Department Head or Designee

 

I understand enrollment in the above requires cancellation prior to class-time if student is unable to attend. (Ext. 2255 or Ext. 2300)

_____________________________________________ Date: _________________________

Signature of Student