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Law Enforcement Innovation Center

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T4 Registration

When completing the registration form, please provide business contact information. Due to the sensitive nature of this training material, the training coordinator will be unable to contact anyone at home or via personal email accounts.

Agency information


* - These Fields Are Required

Training Code*
   Please obtain this code from your agency's training officer.
First Name *
Last Name *
Agency Name *
(PLEASE PROVIDE THE COMPLETE NAME OF YOUR AGENCY - NO ABBREVIATIONS)
Agency Address *
City *
State *
Zip *
Work Phone*

Please note that your confirmation will be sent to the email address provided here. If you prefer to receive your confirmation via fax, please provide that number below. The University of Tennessee respects your privacy and will not share your contact information with any third party.

Email Address
Work Fax
Primary Job Function *
Secondary Job Function
Tertiary Job Function


When will you be attending this course?
Course Start Date *
Course End Date *

Where will you be attending this course?
Course City *
State *
Have you previously attended a WMD/CBRNE course?
Yes
No
If so, please provide the date of the most recent WMD/CBRNE course you have attended.:
Course Date:

Please list any other WMD/CBRNE courses you have taken and provide a brief description.
Brief Description:
Do you hold any special certifications? If so, please choose from the list below:
One
Two
Three

For Title IV compliance, we ask for voluntary disclosure of the following information:

Gender:
Female
Male
Race/Ethnicity:
African American
Asian
Caucasian
Hispanic or Latino
Native American
Native Hawaiian or Pacific Islander
Other
The University of Tennessee will make reasonable accommodations for all persons with disabilities. If you require auxiliary aids, special services, or other accommodations, please check here and someone from our office will contact you.