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FBINAA Charitable Foundation

Law Enforcement Executive Leadership Certificate Program

Tuition Reimbursement Application Form

NOTE: Please provide information in all fields list below and print clearly.

Applicant Details:


Title/Rank:  __________________________________________________________


First & Last Name:  ___________________________________________________ 


Agency/Department Name:  _____________________________________________


Agency/Department Address:  __________________________________________


City, State & ZIP Code:  _______________________________________________


Phone:  ____________________________________________________________


Email Address:  _____________________________________________________


NA Session #:  _______________________________________________________



Course Details:


Indicate Which Law Enforcement Executive Leadership Certificate Program Course You Have Successfully Completed and are a Seeking Tuition Reimbursement Award:


Law Enforcement Executive Leadership Program Undergraduate Certificate Course List:

____ Leadership & Motivation ____ Conflict Resolution with Police Agencies

____ Human Resource Management ____ Budget Development & Execution

____ Strategic Planning ____ Organizational Behavior in Law Enforcement


Law Enforcement Executive Leadership Program Graduate Certificate Course List:

____ Police Administration ____ Grant Writing for Government & Non-Profit Agencies

____ Leadership ____ Organizational Development

____ Organizational Management ____ Strategic Planning


Please submit this completed form along with

Proof of Course Payment & Completion Materials electronically to:

Chief Bob Young  bob.young@fbinaafoundation.org

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