T.E.P. Application

First Name: *

Last Name: *

Address: *

State: Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming *

Phone Number: * *

City: *

Zip Code: * *

Email Address: * *

Drivers License State: Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming *

DL Number *

Ticket Number(1): * *

Charge(1): *

Offense Date(1): * *

Ticket Number(2): *

Charge(2): *

Offense Date(2): * *

Agency: Select Agency -Other- Clover Police Department Fort Mill Police Department Jonesville Police Department Rock Hill Police Department South Carolina Highway Patrol State Law Enforcement Division (S.L.E.D.) State Transport Police Tega Cay Police Department Union County Sheriff's Office Union Public Safety Winthrop University Police York County A.E.T. (YCAET) York County D.E.U. (YCMDEU) York County Sheriff's Office York Police Department *

Officer: *

Court: Select Court -Other- Clover Magistrate Clover Municipal DUI Court (Magistrate) Fort Mill Magistrate Fort Mill Municipal Hickory Grove Magistrate Jonesville City Rock Hill Magistrate Rock Hill Municipal Tega Cay Municipal Union City Union County York County Magistrate York Municipal *

Judge: Must Select Court *

City of Offense: Select City -Other- Adamsburg Bethany Bonham Bowling Green Boyd Hill Buffalo Bullock Creek Carem Carlisle Catawba Clover Concord Country Club Estates Cross Keys Deas Mill Delphia Delta Ebenezer Filbert Forest Lake Fort Mill Friendship Goshen Hill Guthries Harmony Herbert Hickory Grove Hoodtown Hopewell India Hook Jonesville Kelly Kelton Kennedy Mill Lake Wylie Lakewood Lesslie Lockhart Lockhart Junction McConnells Mean Crossroads Mexico Miller Crossing Monarch Newport Ogden Old Point Station Pinckneyville Red River Riverview Robat Rock Hill Roddey Santuc Sedalia Sharon Smyrna South Hills Tega Cay Tirzah Tuckertown Union West Springs York *

County of Offense: Select County -Other- Union York *

Orientation Date: Select Orientation Thursday, February 13, 2025 at 3:00PM Thursday, February 20, 2025 at 3:00PM *