Non-Participating Agency (NPA) Registration Form

Address:

Street Address
Street Address 2
City	State
Zip	Country

Agency Head

Last Name
First Name

Agency Head Email

Peace Officers described in Section 13510.1 of the Penal Code: 830.1, 830.2 (with exception of subdivision (d), 830.3, 830.32 or 830.33. Mark the appropriate Penal Code section related to your agency’s peace officer authority.

Other:

Probationary Period of Peace Officer:

12 months

18 months

24 months

Person completing form (will be our main contact):

First Name
Last Name

Date:

Month

-

Day

-

Year