176820 09/02/2009 CITY OF CARMEL, INDIANA VENDOR: 356864 Page 1 of 1
ONE CIVIC SQUARE KENTUCKY STATE POLICE
is CHECK AMOUNT: $250.00
CARMEL, INDIANA 46032 919 VERSAILLES ROAD
FRANKFORT KY 40601 CHECK NUMBER: 176820
CHECK DATE: 9/2/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
210 4357000 250.00 TRAINING SEMINARS
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c
INVOICE
August 25, 2009
City of Carmel Police Department.
3 Civic Square
Carmel, IN 46032
DARE Officer Training for Officer Wendy Bodenhorn on September $250.00
14 25, 2009 in Elizabethtown, KY
Please make check payable to:
Kentucky State Police DARE Unit
919 Versailles Road
Frankfort, KY 40601
KENTUCKY STATE POLICE
APPLICATION FOR D.A.R.E. OFFICER TRAINING
PARTICIPANT PLEASE PRINT OR TYPE
Last Name or First Middle
In case of emergency contact Telephone lCo5
Do you have any significant health ro lems? V
s
Your name as you wish it to appear on our: Name tent Certificate Aj �e 1
LAW ENFORCEMENT EXPERIENCE Please read and car9fully answer each question
I am a sworn police officer with full enforcement authority: Yes No
Number of years of full time street experience as a sworn officer:
I am assigned or have had assignments to: School Resource dfficer PTUniforrrvPatrol Juvenile
Community/Public Relations Investigations Narcotics
CERTIFICATION Please read and carefully answer each question) YES NO
I understand that D.A.R.E. is an assignment which requires wearing a uniform:
I understand and agree to be monitored by the State Police after certification for guideline compliance:
A school has agreed to use me as their D.A.R.E. Officer:
I am able to completely devote my time and energies to this training:
My calendar is cleared of any and all obligations for the duration of this training:
TO BE COMPLETED BY AGENCY HEAD YES NO
Our agency intends to use the officer /applicant during the next school year.
The applicant/officer will be used: R Full Time Part Time Relief /Substitute
Has the applicant had any disciplinary actions against him/her within the past 3 years n
The applicant/officer will be given sufficient time to properly deliver D.A.R.E. I�1j
I understand that the D.A.R.E. Officer is required to teach in uniform and will be periodically monitored
by the State Police for guideline compliance.
I understand that D.A.R.E. officer Training is a comprehensive program that will demand the undivided
attention of the applicant/officer, and 1. am aware that attendance at all classroom sessions is mandatory: F
I understand that the applicant/officer must successfully demonstrate the knowledge, attitudes and skills
necessary to effectively deliver the D.A.R.E. curriculum in order to be certified and after certification
may be decertified for cause:
APPLICANT SURVEY
I am attending the D.A.R.E. Officer Training seminar because:
0 I have requested to attend. I have been ordered to attend.
I am to evaluate the potential use of this program for my agency, I am not certain.
My knowledge of D.A.R.E.: Very little El Some knowledge Good understanding
How many schools /classes will you be teaching during the next semester? Schools Ll Classes'
Please describe how you were selected for this training. (appointment mpe t the se ection process JJ
Why do you want to be a D.A.R.E. Officer? y T -{-a a, y Q( 4 7
D�s�i�.c -r- ,t.� ryt,�. ����..o� -P at-� �7�►�ur� a„� -tom-
What do you hope to receive during this trainin,;? yj p- t(�I At rJ
e4fn 044141' w O
Have you ever attended or been refused admission to any prior D.A.R.E. Officer Training Class? Yes No
If yes, please explain in detail. (Date, location, training agency, etc.)
AUTHORIZATION
Participant's Signature: fTJ Date:
Agency Head's Si nature:
A 1
Date:
Forward this application and application fee to: Kentucky State olice DARE Unit, 919 Versailles Road, Frankfort, KY 40601
Application fee: In -State $100.00 Out of State $250.00
Revised 05/22/08
CARMEL POLICE DEPARTMENT
APPLICATION FOR SPECIALIZED TRAINING
Today's Date: 08/10/2009 Employee: 2352 w4pol m.//N U✓Z
Name of School: DARE 0
Cost: unknown
Location of School: Elizabeth Town
State: KY
Topic Subject Matter: DARE officer training
Dates of School: From: 09/14/2009 To: 09/25/2009
Contact Person: Bruce Olin
Telephone Number: (502) 695 -6343
How will this School benefit You and the Department? I will be certified to teach inside
the schools.
Will you need C.P.D. Transportation? ®Yes ❑No
Will you need accommodation? ®Yes ❑No
"OVERTIME COMPENSATION WILL NOT BE PAID IF YOU VOLUNTEER
TO ATTEND A SCHOOL, ONLY IF YOU ARE ORDERED TO ATTEND.
Officer's Signature: 9�t�
Supervisor' Signature: Date: ti
Division Commande Date:
Training Officer: Date: CJ it
*OFFICE USE ONLY BE THIS LINE*
s� P!— J�� �_t•-fir /��y
Prescibed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 207 (Rev. 7995)
4
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Kentucky State Police DARE Unit Purchase Order No.
919 Versailles Road Terms
Frankfort, KY 40601 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
8/25/09 payment for DARE Officer training for Officer Wendy 250.00
Bodenhorn on September 14 25, 2009 in Elizabethtown,
KY
Total
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Kentucky State Police DARE Unit IN SUM OF
919 Versailles Road
Frankfort, KY 40601
250.00
ON ACCOUNT OF APPROPRIATION FOR
cont ed fund
Board Members
Po# or INVOICE NO. ACCT #ITITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
210 570 250.00 bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
August 25 20 09
Signature
Chief of Police'
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund