The following Commission-approved forms shall be used by individuals applying for initial or renewal of certification as an instructor or professional lecturer, pursuant to 12 NCAC 09B .0300:

1. (1) Form F-12, Application for Instructor or Professional Lecturer Certification, shall contain the following information:

   1. (a) name of applicant;
   2. (b) address, phone number, email address, date of birth, age, last four of Social Security Number, and academy ID number;
   3. (c) current agency or firm, status (Retired, Civilian, Sworn), agency address, and business phone number;
   4. (d) type of instructor certification applying for;
   5. (e) supporting documents for specific certification sought;
   6. (f) highest education level, school attended, school location, and graduation date;
   7. (g) criminal justice experience;
   8. (h) signature of applicant;
   9. (i) Commission-accredited school taught at, course title, hours taught, course dates, and whether the course was a requirement of Mandatory In-Service Training; and
   10. (j) signature of certifying School Director or In-Service Training Coordinator, school or agency name, phone number, and email address.

2. (2) Form F-16, Criminal Justice Instructor Evaluation, shall contain the following information:

   1. (a) instructor's name, date of birth, and academy ID number;
   2. (b) evaluator's name and academy ID number;
   3. (c) block of instruction, date, location, and total hours of instruction;
   4. (d) scores for Instructional Ability and Strategies; and
   5. (e) Presentation Evaluation Criteria.

History Note: Authority G.S. 17C‑6;
Eff. February 1, 2026.