Satellite Request Form

Satellite Request Form
DSPSI offers two types of satellite courses. The first is in person, where we come to your location for a two-day course. In person satellite courses require a minimum of 10 students. DSPSI will provide one instructor, course instruction, course manual, review, and test. Host will supply venue to accommodate the number of students attending the course, audio and video, and power for all audio and video.

The second is online via Zoom, where you will attend the two-day course online. Online satellite courses require a minimum of 8 students. DSPSI will provide one instructor, course instruction, course manual, review, and test. Prices are per student and can be found on our website under the Certification Price List page.
Requested Date:

MonthDayYear
Date
Primary Certification Course Requested
Secondary Certification Course Requested
*Note all course are 2 Days*
Contact Information
The Public Agency/Company Administrator shall be the ONLY person allowed to request a Satellite.
Contact Name:
Phone #:
Format: (000) 000-0000.
Email Address:
example@example.com
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
City:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
State:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Zip Code:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Billing Contact Information
Contact Name:
Phone #:
Format: (000) 000-0000.
Email Address:
example@example.com
Payment Method:
PO Number:
*Please provide a PO Number for any method other than P-Card
**Note Satellite courses will NOT be approved without payment or PO Number.
Deep South Public Safety Institute
PO Box 87
Breaux Bridge, LA 70517
Forward to: deepsouthpsi@outlook.com
Thank You for choosing DSPSI!
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Satellite Request Form

Contact Information

Billing Contact Information