Contact Information Name First Middle Last (Include Jr., Sr., etc.) Mailing Address ____ Street or Box No. City State Zip SAM Work Phone Fax Number HOUSTON STATE E-Mail Address UNIVERSITY Agency Information Agency Name: ______ Job Title: Drug Impairment Address: ____ Street or Box No. City State Zip Training for Texas How long have you been in this position? Community Supervision Course Information and Parole Officers Facility Name: Hilton Garden Inn (Hosted by Grayson County CSCD) (DITTCSPO) Course Course Location: 5015 South US 75 Denison TX Site Address City State Denison, TX Signature ________ Date Signed January 23, 2018 After completing Registration Form, please RETURN to DRE@SHSU.EDU
SAM HOUSTON STATE UNIVERSITY Drug Impairment Training for Texas Community Supervision and Parole Officers (DITTCSPO) Course Denison, TX January 23, 2018 Contact Information Name First Middle Last (Include Jr., Sr., etc.) Mailing Address ____ Street or Box No. City State Zip Work Phone Fax Number E-Mail Address Agency Information Agency Name: ______ Job Title: Address: ____ Street or Box No. City State Zip How long have you been in this position? Course Information Facility Name: Hilton Garden Inn (Hosted by Grayson County CSCD) Course Location: 5015 South US 75 Denison TX Site Address City State Signature ________ Date Signed After completing Registration Form, please RETURN to DRE@SHSU.EDU
434_reg_form.docx