In accordance with Virginia State Regulation 6 VAC 20-240, the Virginia Department of Criminal Justice Services (DCJS) may approve instructors
to deliver Campus Security Ofcer curriculum training and may revoke such approval for just cause. Applicants for instructor approval may submit
a Request for Waiver of Instructor Approval Application form for review by DCJS outlining previous instructor training or related experience. DCJS
reserves the right to review each waiver application, and evaluate qualications and experience on an individual basis.
Applicant Name (First, MI, Last):
Applicant Title:
Applicant Phone: Email:
Applicant Driver’s License No.: State of License:
School Director/Point of Contact:
School Division:
School Director/Point of Contact Name:
School Director/Point of Contact Phone: Email:
1. Waiver is being sought because the proposed SSO instructor (check all that apply):
qis not currently a Certied School Security Ofcer
qdoes not have a minimum of three (3) years management/supervisory experience in a school security or related eld, or federal, military
police, state, county, or municipal law-enforcement agency
qdoes not have a minimum of ve (5) years general experience as a School Security Ofcer or with federal, state, or local law-enforcement in a
related eld
qhas not completed the DCJS SSO Instructor training; or has one (1) year teaching/instructor experience in an accredited educational institution
or law enforcement agency
qother: ___________________________________________________________________________________________________________
2. Provide any additional information relative to the statement indicated in #1 (you may attach separate sheet of paper detailing information):
3. Attach any supporting documentation which you feel would enhance your application for waiver (e.g., resume, letters of recommendation, training
and certication documentation, etc.).
I, the applicant indicated above, do hereby certify that all entries and attachments to this application are true and complete, is subject to verication,
and consent to DCJS contacting anything referenced on this application. Further, I have read the Standards of Conduct pertaining to School Security
Instructors, as provided in Regulation 6 VAC 20-240 and agree to its content.
Applicant Signature: __________________________________________________________________ Date: ____________________________
I, the School Director/Point of Contact, request DCJS to approve this applicant for instructorship in the delivery of the School Security Ofcer
curriculum.
Point of Contact’s Name: ________________________________________________________________________________________________
Point of Contact’s Driver’s License No.: ________________________________ State of License: ___________ Date: ____________________
Commonwealth of Virginia
Virginia Department of Criminal Justice Services
School Security Ofcer (SSO)
Request for Waiver of Instructor Approval Qualications
Please submit the completed form with documentation to DCJS
Virginia Department of Criminal Justice Services, Division of Law Enforcement, 1100 Bank Street, Richmond, VA 23219
Fax: 804-786-0410 or Email: [email protected]
FOR OFFICIAL DCJS USE ONLY: Instructor approval is granted for the above applicant based on the documentation outlined and included with this Request
for Waiver of Instructor Approval submittal.
Signature: ____________________________________________________ Title: ____________________________________ Date: _______________
Virginia Department of Criminal Justice Services
1100 Bank Street Richmond, VA 23219
www.dcjs.virginia.gov
09/2017