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AOMP Application

A. General Information

1. 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. Preferences will be given to applicants holding command, supervisory, or administrative positions in their departments. North Carolina State University is an equal opportunity institution.
2. 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

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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:

1. Assigned to the Administrative Officers Management Program at North Carolina State University for full-time study.
2. 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
3. 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

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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.

First Name

Middle Name

Last Name

Name of Applicant

Signature of Applicant

Signature NOT required if submitting application via web

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

Spring 2010 Radio buttonSummer 2010 Radio buttonFall 2010 Radio buttonSpring 2011 Radio buttonOther Radio button - text field must be filled inEnter Session

For which session are you applying?

Spring 2010
(Jan 27-April 16)

Summer 2010

(May 12-July 29)

Fall 2010

(Aug 25 - Nov 12)

Spring 2011

(Jan 26 - April 15)

Other (please specify)

For NCSU Registration Confirmation (SS# and DOB are protected) 

First Digit of Social Security Number Second Digit of Social Security Number Third Digit of Social Security Number Fourth Digit of Social Security Number

Last 4 Digits Social Security Number

Year of Birth

Work Email

Present Rank

Date of Rank

Department

Division

Department Phone

Direct Line/Extension

Dept. Address

City

State

Zip Code

Home Address

City

State

Zip Code

Home Phone

Mobile Phone

Home/Personal Email

Year Joined Present Dept.

Total years active law enforcement service

Present assignment duties:

Emergency Contact Name:

Contact Relationship:

Emergency Contact Phone:

What post-secondary schools or colleges have you attended?

Name of School/College

Major?

Dates Attended

Years Completed

Diploma or Degree Earned

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: psli@ncsu.edu

Yes radio button for do you need room arrangements No radio button for do you need room arrangements Radio button for Male (for room assignments) Radio button for Female (for room assignments) Radio button for smoker (for room assignments) Radio button for non-smoker (for room assignments)

Information 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

INVOICING information:

Name

Invoice Contact Email

Department

Division

Address

City

State

Zip Code

Phone Number

	or
Note: Resetting application will erase all information thus provided

If you have any questions please contact us at (919) 515-5149 or via email at psli@ncsu.edu