BILL BLACKWOOD

LAW ENFORCEMENT MANAGEMENT INSTITUTE

OF TEXAS

A Member of the Texas

State University System

Leadership Command College

Application for Admission

Admission to the Leadership Command College is competitive and is based on a number of factors which include:

Current employment with a public law enforcement agency in Texas, in a full-time paid capacity

A minimum of five (5) full-time years paid employment in a public law enforcement agency in Texas

Currently and during attendance of each module candidate must be assigned in a mid-management command or administrative position with a minimum of two years in that capacity

A fully completed application

Attend and Participate in the Program Overview assigned to

Review and decision by Candidate Assessment Coordinator

INSTRUCTIONS FOR COMPLETING THIS APPLICATION:

Answer each question as completely as possible. If necessary, you may attach additional sheets of paper. It is not necessary to attach copies of college transcripts, diplomas, birth certificates, commission certificates or other similar documents.

If you have any questions, please call the Institute at:

(936) 294-4807 or (800) 477-9248

Mail completed applications to:

Bill Blackwood

Law Enforcement Management Institute of Texas

Attention: LCC Program Coordinator

SHSU, Box 2417

Huntsville, Texas

77341‑2417

BILL BLACKWOOD

LAW ENFORCEMENT MANAGEMENT INSTITUTE

OF TEXAS

A Member of the Texas

State University System

Leadership Command College

Application for Admission

Please type or print legibly

Part I – Personal Information

Name: __________________________________________________________________________

Last First MI

Preferred First Name: ________________ Social Security Number: __________ Date of Birth: ________

Ethnicity: African American Native American Hispanic Asian White Other

Gender: Male Female PID#:_________ Rank/Title: (Chief, Capt., Lt., etc.): _____________________

Agency Name: ____________________________________________________________________

Chief Executive Officer: ____________________________________________________________

Agency Type:

Municipal Police Department Sheriff's Office

Constable's Office College/University Police

Special District (airport, park, metro, etc.) Independent School District

State Law Enforcement Out of State Law Enforcement

Federal Law Enforcement International Law Enforcement

Total Sworn Personnel: _______________ Department Logistics: ______ Patrol Officers

______ Sergeants

LEMIT USE ONLY

LCC # ____________________________

__________________________________

______ Lieutenants

______ Captains

______ Other

Name: __________________________________________________________________________

Last First MI

REQUIRED:

Department Mailing Address: _________________________________________________________

City: ______________________________ State: ________ County: ____________ Zip: _________

Agency Telephone Number: (____) ___________________FAX Number: (____) ______________________

Preferred Telephone Number (for daytime contact): (____) ___________________________

Work Email address:___________________________@________________________________________

OPTIONAL:

Home Mailing Address: _____________________________________________________________

City: ______________________________ State: ________ County: ____________ Zip: _________

Home TX Number: (____) ___________________ Home FAX Number: (____) ____________________

Home email address: _____________________________@______________________________________

Part II – Work Experience

Do you currently hold a commission with the Texas Commission on Law Enforcement Officer Standards and Education or from a law enforcement licensing agency from another state? __Yes__No

If no, are you certified in any other state? __Yes__No List state: _________________________

Are you a licensed peace officer? __Yes__No

Summarize your experience as a paid full‑time member of a law enforcement agency in the following chart.

Work category	Years experience
Operations level
First line supervisor
Mid manager
Commander/Assistant CEO
Chief Executive Officer
TOTAL

Name: __________________________________________________________________________

Last First MI

WORK EXPERIENCE CONTINUED:

Check the category that best describes your current job responsibilities.

Check one	Current work category	Description
	Mid manager	Supervisor of other supervisors in a single functional area
	Commander or Assistant CEO	Supervisor of other supervisors in multiple functional areas
	Chief Executive Officer	Chief executive officer or elected administrator
	Other	Describe:

Part III – Education/Training

List the police academy you attended.

List all schools (high school, college, university, vocational or academy) attended.

Name and location of institutions attended

Hours completed

Degree, Diploma or License

Date completed

Education Level: Less than Associates Degree or 60 hours of college

Associates Degree or over 60 hours college with no degree

Bachelor's Degree

Master's Degree

Terminal Degree

Name: _______________________________________________________________________________

Last First MI

Part IV – Additional information

Please include copies of the following and staple them to this application before mailing:

A Departmental Organizational Chart indicating your current position.

The Job Description of your current position on department stationary.

Name: __________________________________________________________________________

Last First MI

Part V – Statement of Commitment

The Leadership Command College is an intensive educational program requiring a sincere commitment of time away from your agency and the completion of a comprehensive written research project. Please read and sign the following statement.

Applicant's Statement of Commitment

I understand that if selected to attend the Leadership Command College, I will be required to attend three 15 day modules.

I will be required to complete and defend a comprehensive written leadership white paper.

I have read the LCC Rules and Guidelines and agree to abide by them.

I personally agree to complete all work assignments and projects assigned by the Institute within the required time frames. All written projects will be the result of my own independent research. I agree that, if I do not make regular progress I may be suspended or removed from the Institute.

I intend to continue employment within the public sector for a period of not less than 3 years to apply the knowledge and skills acquired through the Leadership Command College.

____________________________________________________________________________ _________________________________

Applicant's signature Date signed

Part VI – Agency Nomination (optional)

Admission to the Leadership Command College does not require the nomination of your agency. However, your likelihood for admission and completion are greatly enhanced if your supervisors are aware of the commitment you are making to improve your ability to perform in a law enforcement agency. If your agency supports your commitment to attend the Institute, please ask your immediate supervisor or agency executive to read the above statement of commitment and sign below in the space provided.

I have read the statement of commitment and will support this applicant's attendance at the Leadership Command College.

____________________________________________________________________________ _________________________________

Typed or printed name Title

____________________________________________________________________________ _________________________________

Signature Date signed