TEXAS DEPARTMENT OF PUBLIC SAFETY
CERTIFICATE OF TRAINING FORM
This is to certify that
NAME:LASTFIRSTM.I.
successfully completed a course of instruction and demonstrated proficiency under Texas Government Code, §411.188 and is hereby awarded a certificate of training. By my signature below, I certify that I am currently certified by the Texas Department of Public Safety as an instructor. The classroom training provided to the individual named above meets all statutory and regulatory requirements under Chapter 411, Government Code and Title 37, Texas Administrative Code, Chapter 6. I also certify that all of the information on this form is true and correct to the best of my knowledge.
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STUDENT’S STATE DRIVER LICENSE or |
CLASSROOM |
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IDENTIFICATION CARD NUMBER: |
_______ |
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________________________ |
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PASS / FAIL |
PROFICIENCY
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PASS / FAIL
CLASSROOM TRAINING
Topic |
Time allocation |
Use of Force: |
____hr ____ min |
Safe storage: |
____hr ____ min |
Non‐Violent Dispute: ____hr ____ min
Handgun use: |
____hr ____ min |
________________ |
____hr ____ min |
________________ |
____hr ____ min |
________________ |
____hr ____ min |
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Total Class Time: |
____hr ____ min |
INSTRUCTOR INFORMATION
Printed Name: _________________
Instructor Number:______________
Location:______________________
______________________
Date(s): ______________________
_____________________________
Instructor Signature
PROFICIENCY TRAINING |
INSTRUCTOR INFORMATION |
Action Type: |
SA NSA |
Both |
Total Range Time: |
____hr ____min |
(Instructor renewal requires both weapons) |
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_____________________________
Instructor Signature
Printed Name: _________________
Instructor Number:______________
Location:______________________
______________________
Date(s): ______________________
Total Class Time |
Total Range Time |
Total Training Time |
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____hr ____min |
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____hr ____min |
____hr ____min |
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Renewal training time must be at least 4 hours |
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Original training time must be at least 10 hours |
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Student’s Signature ________________________________________ |
Attach original signed CHL‐100 to the completed application. |
Retain a copy of the CHL‐100 for your records. CHL‐100 (Rev. 08/11) |
INSTRUCTIONS FOR CHL-100 (CERTIFICATE OF TRAINING FORM)
PURPOSE:
The CHL-100 form is to be completed by a certified Texas Concealed Handgun Instructor for each student attending the Concealed Handgun License (CHL) classroom and/or proficiency training required by Texas Government C ode Chapter 411.
Per Texas Government Code §411.188, students making an application for an original CHL, must complete a minimum of 10 hours of training by a certified Texas Concealed Handgun Instructor. Students making an application for renewal of a CHL must complete four (4) hours of training by a certified Texas Concealed Handgun Instructor.
Texas Administrative Code §6.11 specifies the course of fire required for demonstration of proficiency. (http://www.txdps.state.tx.us/administration/crime_records/chl/chlQualCourse.pdf)
Texas Administrative Code §6.87 requires instructors to make this record, as well as other documents, available for inspection and requires the records to be maintained for three (3) years after course completion.
The original CHL-100 should be given to the student and a copy maintained by the instructor. CHL applicants should submit the original to the Regulatory Services Division with the application and/or supporting documents.
REQUIRED INFORMATION:
Classroom Training –
Student’s Name
Student’s Driver License or Identification Card number and two digit State (example: 99999999 TX)
Pass or Fail verification (example: Pass)
Completely fill in the circle indicating if the student is applying for a Renewal or Original.
The amount of time taught for each of the four (4) required topics. Add additional topics covered and the amount of time spent on each additional topic. (If you have more topics than there are blanks, you may combine topics)
The total number of hours taught in the classroom.
Proficiency Training –
Completely fill in the circle indicating the type of weapon the student used for demonstrating proficiency. O SA = Semi Automatic
O NSA = Non-Semi Automatic (revolver)
O Both = Only for required for instructor certificate renewal
The amount of time spent on proficiency at the Range.
Signature of the instructor.
Instructor Information –
Printed name of the instructor.
Instructor certificate number.
Location where the training occurred. This may be a business address or a 911 address if the training did not occur at a place of business.
All dates when the training occurred. (example: 8/1/2011-8/2/2011)
Signature of the instructor responsible for the training. If multiple instructors provided training, only the primary instructor is required to sign.
Total Training Time –
The total number of hours taught in the classroom, time spent on the range and the total instruction time.
The student must sign the CHL-100.
Updated 8/2011
