In the realm of federal law enforcement training, the FTC-CTD-01 form emerges as a crucial document for those seeking to partake in specialized programs aimed at enhancing homeland security. Issued by the Department of Homeland Security's Federal Law Enforcement Training Center (FLETC) Counterterrorism Division, this form serves as a gateway for federal, state, and local law enforcement officers to register for training designed to bolster their skills in counterterrorism efforts. The form requires detailed information from applicants, including personal identifiers and professional details, to effectively manage the registration process. It not only captures basic information such as the program title, dates, and location of training but also delves into specifics like department address, contact numbers, and the number of sworn law enforcement officers within an applicant's department. Additionally, it outlines the protocol for financial reimbursement for tuition-based programs, ensuring applicants understand their financial commitments before enrolling. The form's privacy act statement underlines the legal foundations for collecting this information, its intended uses, and the implications of nondisclosure, emphasizing the significance of providing accurate information. Importantly, it highlights the conditions under which personal and professional data gathered through the form may be shared with other governmental bodies for law enforcement or other official purposes, underlining the serious nature of the training and the responsibilities of those participating.
| Question | Answer |
|---|---|
| Form Name | Form Ftc Ctd 01 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | counterterrorismdivision, Counterterrorism, Glynco, fletc |
Department of Homeland Security Federal Law Enforcement Training Center Counterterrorism Division
“We train those who protect our homeland”
FEDERAL, STATE AND LOCAL TRAINING REGISTRATION REQUEST
PROGRAM TITLE (required)
DATES OF TRAINING (required) |
LOCATION OF TRAINING (required) |
|
|
NAME (as you want it to appear on certificate)
SOCIAL SECURITY NUMBER
(see attached privacy act statement)
RANK/TITLE
SEX
Male
Female
DEPARTMENT ADDRESS
Department/Agency Name ___________________________________________________________________________
Street: |
______________________________________________ P.O. Box: ________________________________ |
||
City: |
_______________________________________ |
State: ________ |
Zip Code: ____________ |
OFFICE TELEPHONE NUMBER
( ) _____ - ________
FAX TELEPHONE NUMBER
( ) _____ - ________
AGENCY TYPE |
|
|
State |
Local |
Tribal Campus Police |
Federal DHS
Federal
Other ________________________
Number of Sworn Law Enforcement Officers in your Department?
RETURN THIS FORM TO:
Federal Law Enforcement Training Center
Counterterrorism Division
Program Specialist Advance Programs
1131 Chapel Crossing Road
Townhouse 391, Glynco, GA 31524
Phone:
Email:
IMPORTANT INFORMATION
Confirmation:
A confirmation letter with details of the training will be provided upon acceptance into the program. This form is used to REQUEST registration. Before making travel arrangements, please ensure you are actually registered in the program. Please do not remit payment, if applicable. Your agency will be billed upon program completion for any program costs.
Private Organization:
Applicants from private organizations must be sponsored by a state, local, or federal law enforcement agency.
Financial Reimbursement (This block MUST be completed for
The ______________________________ agrees to reimburse the
FLETC for training services provided. The FLETC will bill for the actual cost of training during the month after the program is completed. Please provide the following billing information:
Dept./Agency Name: ___________________________________
Mailing Address: ___________________________________
City, State, Zip Code: __________________________________
Federal ID Number: |
__________________________________ |
Contact Person: |
__________________________________ |
Telephone: |
__________________________________ |
Fax: |
__________________________________ |
Authorized Signature: _________________________________
(Supervisor or Financial Manager)
Privacy Act Statement
Authority
The authority to collect the information is derived from the Government Employees Training Act, 5 USC
Purpose and Uses
The information you supply will be used to assist the government in retrieving information documenting your training. If you furnish none of the information requested, your attendance in training will be immediately terminated. These records and information in the records may be used to: (1) disclose pertinent information to appropriate Federal, state, local or foreign agencies responsible for investigating or prosecuting the violations of, or for enforcing or implementing, a statute, rule, regulation, order, or license, where the disclosing agency becomes aware of an indication of a violation or potential violation of civil or criminal law or regulation; (2) disclose information to a Federal, State, or local agency, maintaining civil, criminal or other relevant enforcement information or other pertinent information, which has requested information relevant to or necessary to the requesting agency's or the bureau's hiring or retention of an individual, or issuance of a security clearance, license, contract, grant, or other benefit; (3) disclose information to a court, magistrate, or administrative tribunal in the course of presenting evidence. Other routine uses can be found in FLETC Privacy Act System of Records Notice FLETC .002 – FLETC TRAINEE RECORDS.
Effects of Nondisclosure
If you furnish only part of the information required, an attempt will be made to maintain and process your records. If the information withheld is found to be essential to effectively maintaining and processing your records, you will be so informed, and your training will terminate unless you supply the missing information.
Disclosure of your Social Security Number (SSN)
Disclosure by you of your Social Security Number (SSN) is not mandatory. Solicitation of the SSN is authorized under the provisions of Executive Order 9397 dated November 23, 1943. The SSN will be used only as necessary in connection with retrieving your records. The use of the SSN is made necessary because of the large number of present and former students who attend or have attended Center Programs, and who potentially may have identical names and birth dates and whose identities can only be distinguished by the SSN.