CPL Introduction and Reg
M CPL
State of Michigan
Concealed Pistol Class
Start Your Training Today No Waiting
24/7 Registration
Handgun Training Specialists 556 Tennyson, Rochester Hills, Mi. 483 07 248-309-9579
vers 3.0
Convenient Blended Learning
Save Time / Save Money / Learn More
All the information you need in one location
Meets and Exceeds the state minimum re g uirements
The 3 step process is automatic and E Z Zto do. CPL Program Registration F ee: $ 1 4 0 .00 1. Click on REGISTRATION and complete the registration form 2. Make the Payment 3. When payment is complete you will be automatically redirected to the complete set of Online documents ready to download to your computer and start training.
Questions or comments Phone and text 248-309-9579 E mail: protectsystems@sbcglobal.net Information request form
Continue below for more information - return to this page when ready to register and start your training
CPL
Michigan Concealed Pistol Class
Blended Learning Program Introduction and Class content outline
CPL Laws and legal Liability
Shooting Skills and Range Safety
Use of Deadly Force in Self Defense
NRA Module
Four Knowledge Modules You Will need to Know
Handgun Training Specialists A division of Protect Systems Training Academy 5 56 Tennyson Rochester Hills, Mi. 48307 248-309-9579
Select a link to Learn m ore about blended learning program and register when ready Student Support Section Blended Learning Course Outline NRA Study Module CPL Course Specific Module Use of Force Module Range Safety and Shooting Skills Covid-19 Policy
Instructor and Attorney CPL Process and Fees Michigan CPL Training Requirements CPL Application Form
Blended Learning Concealed Pistol Course
248-309-9579
We teach the NRA Personal Protection In the Home CPL course. This is a State of Michigan approved 12-hour Course Training is a three-part process . 1. Online self-study estimated time is 5 + hours (no time limit) 2. Zoom virtual classroom training: 4 hours required (2) 2. 0 -hour sessions 3. Range session: 2 .0 hours Total time: 10 .0 hours 6 .0 hours instructor controlled 4.0 hours self-study Basic requirements: The student and instructor are required to establish a “classroom environment ” that allows face to face contact with direct interaction between instructor and student. This will require the student to have a webcam or smart phone. The setup and use of the zoom virtual classroom is easy to manage. If you are a first-time user and would like some help, your instructor will guide you through the process . The training process is started with the student registering for the class and downloading the class study material. 1.Part one : Self-study class preparation: The student should download study material in preparation for the ZOOM classroom session. (instructor assistance available) Here we have gathered all the material you will need for the CPL course The program contains 4 knowledge modules, with each containing a written test to assess the persons knowledge of the topic. Separating the content into individual four identifiable parts allows the user to identify their strengths and weakness regrading each topic. This helps eliminate confusion or a misunderstanding of using and applying the practical application of the module content.
Complete each section and submit to back to our office for correction Corrected tests will be reviewed during ZOOM session
I nstructor Assistance Phone: 248-309-9579 Monday- Friday 9am-9pm Saturday and Sunday 9am-5pm 24/7 Text 248-309-9579 Help Site click here
3DUW 2QH Modules 1. NRA PPITH content 2. CPL Specific content 3. The Use of Deadly Force in Self Defense 4. Range Safety and Shooting Skills
10 videos and 2 PowerPoint presentations used in the four training modules. Videos are presented in an easy- to-use format and are selected and designed to enhance the user’s knowledge and understanding of the material Part two - Zoom virtual classroom Module - 5 Hours (2) 2.5-hoursessions This part contains the following: 1. NRA Personal Protection in the Home segment - PowerPoint 2. Review written test 3. Live Fire Range preparation 4. Covid-19 range safety procedures Part Three - Live Fire Range T ime Training Fees: Individual registration: $ 150.00 each Groups of 2 or more: 140.00 each 2XU H[FOXVLYH 2QH )HH 3D\V $OO SURJUDP LQFOXGHV WKH IROORZLQJ 1. Classroom and instructor fees 2. Range Fees . The use of a .22 semi auto handgun (does not include ammunition) (While not necessary, we encourage people to bring their own handgun if possible). A minimum of 50 rounds is required for the class. Eye and ear protection Sanitizing wipes and decontamination equipment (see our Covid-19 safety statement)
CPL Class Registration
6 t DUW your training RQ OLQH , and receive the download documents. Use our request form for more information
Please continue to end of document for more information . Then return to register
NRA
Training Module
NRA StudyModule
Complete the 6 NRA documents below and take test
1. NRA Personal Protection In The Home video above – 60 min run Time 2. NRA The Mindset of Handgun Self Defense.pdf 65 five slides NRA PPITH PowerPoint Lessons - 3. lesson one The Basics of Pistol Shooting 4. Lesson two Ammunition and the Fundamentals of Pistol Shooting 5. Lesson Three Firing The First Shots 6. Lesson four scoring targets and selecting and maintain your pistol NRA Specific - 25 Questions
Module 2
CPL Specific Content
Study Guide Manual
State and Federal CPL Content Specific Study Manual Review manual complete attached test at end of this page
Michigan CPL training program --------------------------------------------------------- 1 Concealed pistol application form ----------------------------------------------------- 2-3 Concealed pistol application procedure ---------------------------------------------- 4-5 Handgun purchase procedure ---------------------------------------------------------- 6-9 Pistol Free Areas -------------------------------------------------------------------------- 10-11 Safe Storage ------------------------------------------------------------------------------------- 12 Carry Under the influence------------------------------------------------------------------- 13 Possession of another person’s handgun -------------------------------------------- 13 Proper conduct during encounters with the police -------------------------------- 14 Reciprocity ---------------------------------------------------------------------------------- 15 -16 Michigan handgun transportation laws -------------------------------------------------17 Weapons and the CPL -------------------------------------------------------------------------18 Michigan State Parks -------------------------------------------------------------------------18 State of Michigan Firearms Definition -------------------------------------------------- 19 Stand Your Ground Module ---------------------------------------------------------- 20 - 28 Federal Laws NFA Firearms ----------------------------------------------------------------------------------- 29 National Park System -------------------------------------------------------------------------30 Guide to The Interstate Transportation of Firearms –-------------------------31- 36 The Interstate purchase and sale of firearms ----------------------------------------37 Youth Handgun Safety Act Notice -------------------------------------------------- 38 -39 ATF Regulations-------------------------------------------------------------------------- 40– 45 Self Defense Definitions – Honest and Reasonable-------------------------------------------------------------- -46 - 49 "Clean hands" Doctrine ------------------------------------------------------------------ 50 Case law - -------------------------------------------------------------------------------------- 50 Attorney General’s opinion--------------------------------------------------------------- 50 Court Opinions ------------------------------------------------------------------------------ 50 Jury Instructions ---------------------------------------------------------------------------- 51 Selected Firearms Laws of Michigan------------------------------------------------- 79 Our Staff - --------------------------------------------------------------------------------------------- CPL Specific module written test- 30 questions
0RGXOH
8VH RI Deadly )RUFH in Self Defense
,ĂŶĚŐƵŶ dƌĂŝŶŝŶŐ ^ƉĞĐŝĂůŝƐƚƐ ϮϰϴͲϯϬϵͲϵϱϳϵ
Use of Deadly Force in Self Defense Table of Contents 1. Concealed Carry and Self Defense
2. The Elements of the use of Deadly Force 3. Basic Rules of Deadly Force Engagement 4. The Use of Force and subject control 5. Force on force and the escalation of force 6. The use of force continuum 7. The reaction gap and the use of deadly force 8. Use of force Options Example 1 Example 2 9. T he escalation of the use of force char t 10. Public Acts 309 – 314 of 2006 comprise the “Self-Defense Act.” 11. General Provisions of the Self Defense Act 12. The Rebuttable Presumption 13. There is no duty to retreat if the following four factors are present 14. Responsibility after Using Force 15. Your Constitutional Rights 16. Self Defense Jury Instructions 17. Factors that influence the decision to use a firearm for self defense
18. Self Defense Definitions 19. The Clean Hands Doctrine 20. The first responder
20 Quest ion Use of Force test
Module 4
ZĂŶŐĞ ^ĂĨĞƚLJ ĂŶĚ ^ŚŽŽƚŝŶŐ ^ŬŝůůƐ
ϮϰϴͲϯϬϵͲϵϱϳϵ
Range Safety and Shooting Skills Table of Contents
Basic Range Safety Rules NRA Fundamentals of Shooting Skills Basic HandgunShooting Fundamentals The process of sight alignment and sight picture Correct and incorrect sight alignment Self DefenseTechniques The Acc-u-check target system HandgunSafetyand Shooting Skills written test - 15 question 15 question written test
COVID-19
Policy and Procedure Statement
Handgun Training Specialists 248-309-9579
COVID-19 Range Procedures We use two ranges for live fire training
x The Pontiac Lake Recreation Area (outdoor range) x Accurate Range in Clarkston Mi. (indoor range) (Outdoor range is preferred weather permitting) Safety Procedure:
1. Face masks must always be in use when social distancing cannot be maintained 2. Body temp checks are taken at training location before allowed on the range. 3. Consider anything you touch that could have been handled by another person as contaminated. This would include: x Door handles x Range operating equipment x Tables and chairs
Wash hands immediately after range time. We supply the following safety equipment: x Hand Sanitizer x Surface wipes x Goggles that fit over glasses x Contactless digital infrared thermometer x UV decontamination surface wand
6XUIDFH 89 GHFRQWDPLQDWLRQ VFDQQHU &DQ EH XVHG WR GHFRQWDPLQDWH DQ\WKLQJ EXW SHRSOH
Instructor and Attorney
Gerald Wrage: Owner NRA Firearms Instructor NRA Range Safety Officer NRA Law Enforcement Instructor Firearms Law and Use of Force Instructor Former law enforcement and training sergeant Crime Prevention Specialist
Michael S. Klockow, Esq Attorney and Counselor Concealed Pistol Arrests and Violations Firearms legal issues
Gerald Wrage – Brief Autobiography 30 years of experience as a professional instructor and training program development.
Skill Set and Job Experience NRA Certified Firearms Instructor NRA Certified Range Safety Officer
Former NRA Law enforcement handgun and shotgun instructor OCSD - R eserve officer, Reserve Training Sargent, and Park Deputy Securitas Security Services : Director and chief instructor of armed officer division. Job description included : Handgun Training, Pepper Spray, Defensive Tactics, Handcuffing and ASP Baton. Huffmaster Associates – Private Investigations and Security Special work assignments that required an armed PI and Bodyguard/personal protection details. Owner of Protect Systems Training Academy : Civilian, Security Guard and Law enforcement training. Only civilian owner and operator a Law enforcement grade shooting simulator. With use of force and training in the use handguns, rifles, shotguns, pepper spray and tasers. A Partial list of Training and Education Oakland County Sheriff’s Dept. Reserve Police Academy I n-service training programs MCOLES approved training for Basic Firearms and Police Shotgun Instructor certification Detroit Police Academy - crime prevention school. The University of Louisville's National Crime Prevention Institute with special training in crime prevention and security. The Lethal Force Institute - training in the use of deadly force by civilians in self defense. The National Criminal Justice Training Council - Law enforcement use of force Instructor. Schoolcraft Collage Law Enforcement Division - In-service Firearms and Police Shotgun Instructor certification course Expert witness testimony and depositions, with experience in misdemeanor and felony charges and prosecution. Concealed Pistol expert witness testimony regarding concealed pistol Laws, legal Liability, and the use of a firearm in self-defense.
CPL Process and Fees
1. Complete the training process and applicant is issued a certificate of completion. 2. Certificate and Finger Printing. 3. The application is processed by your local county clerk’s office. 4. Your fingerprints are taken at the sheriff’s office on the same day as the application process. 5. Both are in the county complex at 1200 N. Telegraph Rd. Pontiac, Mi. 6. The application fee is $100.00 paid at the time of application. 7. Fingerprint fee is separate fee of $ 15.00 paid at the time processing. Oakland County phone numbers County Clerks: 248-858-0571 Other County applicants: The process is the same. check with your county clerk. Application: 100.00 Fingerprint: 15.00 Ammunition: $ 20.00 Average total costs per person: $ 285.00 License is valid for 5 years Ammunition is short supply and expensive. We can supply one 50 round box per person at the following prices: (Based on our purchase price) .22 caliber: $ 15.00 9mm: $ 25.00 We (HGTS) accept cash, checks and credit cards. Total applicant fees: Training: 150.00
Michigan CPL Training Requirements 28.425j Pistol training or safety program; conditions.
Sec. 5j. (1) A pistol training or safety program described in section 5b(7)(c) meets the requirements for knowledge or training in the safe use and handling of a pistol only if the program consists of not less than 8 hours of instruction and all of the following conditions are met: The program is certified by this state or a national or state f irearms training organization and provides 5 hours of instruction in, but is not limited to providing instruction in, all of the following: The safe storage, use, and handling of a pistol including, but not limited to, safe storage, use, and handling to protect child safety. Ammunition knowledge, and the fundamentals of pistol shooting. Pistol shooting positions. (iv) Firearms and the law, including civil liability issues and the use of deadly force. This portion shall be taught by an attorney or an individual trained in the use of deadly force. Avoiding criminal attack and controlling a violent confrontation. All laws that apply to carrying a concealed pistol in this state. (b) The program provides at least 3 hours of instruction on a firing range and requires firing at least 30 rounds of ammunition . (c) The program provides a certificate of completion that states the program complies with the requirements of this section and that the individual successfully completed the course, and that contains the printed name and signature of the course instructor. Not later than October 1, 2004, the certificate of completion shall contain the statement, "This course complies with section 5j of 1927 PA 372." (d) The instructor of the course is certified by this state or a national organization to teach the 8-hour pistol safety training course described in this section. A person shall not do either of the following: Grant a certificate of completion described under subsection (1) (c) to an individual knowing the individual did not satisfactorily complete the course. Present a certificate of completion described under subsection (1) (c) to a concealed weapon licensing board knowing that the individual did not satisfactorily complete the course. (3) A person who violates subsection (2) is guilty of a felony punishable by imprisonment for not more than 4 years or a fine of not more than $2,500.00, or both. A concealedweapons licensing board shall not require that a specific form, color, wording, or other content appear on a certificate of completion, except as provided in subsection (5), and shall accept as valid a certificate of completion issued prior to the effective date of the amendatory act that added this subsection that contains an inaccurate reference or no reference to this section but otherwise complies with this section. BeginningOctober 1, 2004, a concealedweapons licensing board shall require that a certificate of completion contain the statement, "This course complies with section 5j of 1927 PA 372.” History: Add. 2000, Act 381, Eff. July 1, 2001; Am. 2002, Act 719, Eff. July 1, 2003; Am. 2004, Act 254, Imd. Eff. July 23, 2004. Popular name: CCW
5, 0LFKLJDQ 6WDWH 3ROLFH 3DJH RI
CONCEALED PISTOL LICENSE APPLICATION I. General Information: 7\SH RU FOHDUO\ SULQW LQ LQN DQVZHUV WR DOO ILHOGV )XOO /HJDO 1DPH ,QFOXGH 6XIIL[
'DWH RI %LUWK
3UHYLRXV 1DPHV $OLDVHV RU 0DLGHQ 1DPHV ,I $SSOLFDEOH
'D\WLPH 3KRQH 1XPEHU
D 6RFLDO 6HFXULW\ 1XPEHU 9ROXQWDU\
E (PDLO $GGUHVV 9ROXQWDU\
D 'ULYHU¶V /LFHQVH 1XPEHU RU 3HUVRQDO ,GHQWLILFDWLRQ 1XPEHU
E 'ULYHU¶V /LFHQVH RU 3HUVRQDO ,GHQWLILFDWLRQ 6WDWH RI ,VVXDQFH
D 3ULPDU\ 5HVLGHQFH $GGUHVV
E 3ULPDU\ 5HVLGHQFH &LW\
F 3ULPDU\ 5HVLGHQFH =,3 &RGH
D 0DLOLQJ $GGUHVV ,I 'LIIHUHQW
E 0DLOLQJ &LW\
F 0DLOLQJ =,3 &RGH
D 5DFH
E *HQGHU
F +HLJKW
G +DLU &RORU
H (\H &RORU
&RXQW\ RI 5HVLGHQFH
3ODFH RI %LUWK 6WDWH RU &RXQWU\
$UH \RX D 8 6 FLWL]HQ" D $UH \RX D /HJDO ,PPLJUDQW $OLHQ" E $OLHQ 5HJLVWUDWLRQ 1XPEHU F &RXQWU\ RI &LWL]HQVKLS D $UH \RX ODZIXOO\ UHJLVWHUHG WR YRWH LQ 0LFKLJDQ" 1R E $UH \RX RQ DFWLYH GXW\ VWDWXV ZLWK WKH 8QLWHG 6WDWHV $UPHG )RUFHV VWDWLRQHG RXWVLGH RI 0LFKLJDQ EXW \RXU KRPH RI UHFRUG LV LQ 0LFKLJDQ" F $UH \RX RQ DFWLYH GXW\ VWDWXV ZLWK WKH 8QLWHG 6WDWHV $UPHG )RUFHV SHUPDQHQWO\ VWDWLRQHG LQ 0LFKLJDQ EXW \RXU KRPH RI UHFRUG LV RXWVLGH RI 0LFKLJDQ" 1R II. Type of License: &KHFN WKH ER[ QH[W WR WKH W\SH RI OLFHQVH WKDW DSSOLHV WR WKLV DSSOLFDWLRQ Standard – $SSOLFDWLRQ IRU 6WDQGDUG /LFHQVH Emergency – 3HUVRQDO 3URWHFWLRQ 2UGHU 2EWDLQHG Emergency – 6KHULII Renewal – ,I UHQHZLQJ DQ H[LVWLQJ 6WDQGDUG OLFHQVH FRPSOHWH WKH UHQHZDO LQIRUPDWLRQ DQG FHUWLILFDWLRQ EHORZ 1. Renewal Information D ([SLUDWLRQ 'DWH RI &XUUHQW &3/ E &RXQW\ RI ,VVXDQFH F 1DPH RQ 3UHYLRXV /LFHQVH G &3/ 1XPEHU 2. Renewal Certification , FHUWLI\ WKDW , KDYH FRPSOHWHG DW OHDVW WKUHH KRXUV RI UHYLHZ RI WKH UHTXLUHG WUDLQLQJ DQG KDYH KDG DW OHDVW RQH KRXU RI ILULQJ UDQJH WLPH LQ WKH VL[ PRQWKV LPPHGLDWHO\ SUHFHGLQJ WKLV DSSOLFDWLRQ 6LJQDWXUH 'DWH III. Survey: $QVZHU \HV RU QR WR WKH IROORZLQJ TXHVWLRQV +DYH \RX HYHU EHHQ FRQYLFWHG RU DGMXGLFDWHG DV D MXYHQLOH RI D IHORQ\ LQ WKLV VWDWH RU HOVHZKHUH" 1R 'R \RX KDYH D IHORQ\ FKDUJH SHQGLQJ LQ WKLV VWDWH RU HOVHZKHUH" 1R 5, 0LFKLJDQ 6WDWH 3ROLFH 3DJH RI III. Survey (continued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greement and Certification %\ VLJQLQJ EHORZ \RX DFNQRZOHGJH WKH IROORZLQJ VWDWHPHQWV DUH WUXH x , KDYH UHDG WKH LQIRUPDWLRQ SURYLGHG RQ FDUU\LQJ D FRQFHDOHG SLVWRO DQG REWDLQLQJ D 0LFKLJDQ &3/ , PHHW DOO WKH FULWHULD IRU REWDLQLQJ D &3/ DQG , GR QRW KDYH D KLVWRU\ RI PHQWDO LOOQHVV WKDW ZRXOG GLVTXDOLI\ PH IURP REWDLQLQJ D &3/ XQGHU WKH )LUHDUPV $FW 3$ DV DPHQGHG x , JLYH DXWKRULW\ WR WKH 063 WR DFFHVV DQ\ UHFRUG QHHGHG WR SHUIRUP LWV UHTXLUHG YHULILFDWLRQ WKURXJK WKH /DZ (QIRUFHPHQW ,QIRUPDWLRQ 1HWZRUN /(,1 DQG WKH 1DWLRQDO ,QVWDQW &ULPLQDO %DFNJURXQG &KHFN 6\VWHP 1,&6 x , XQGHUVWDQG WKDW P\ SHUVRQDO LQIRUPDWLRQ DQG ELRPHWULF GDWD EHLQJ VXEPLWWHG E\ /LYHVFDQ ZLOO EH XVHG WR VHDUFK DJDLQVW LGHQWLILFDWLRQ UHFRUGV IURP ERWK WKH 063 DQG )%, IRU WKH SXUSRVH RI YHULI\LQJ P\ HOLJLELOLW\ WR REWDLQ D &3/ , KHUHE\ DXWKRUL]H WKH UHOHDVH RI P\ SHUVRQDO LQIRUPDWLRQ IRU VXFK SXUSRVH DQG UHOHDVH RI DQ\ UHFRUGV IRXQG E\ WKH 063 x 'XULQJ WKH SURFHVVLQJ RI WKLV DSSOLFDWLRQ DQG IRU DV ORQJ DV P\ ILQJHUSULQWV DQG DVVRFLDWHG LQIRUPDWLRQ ELRPHWULFV DUH UHWDLQHG E\ WKH 6WDWH DQG RU )%, WKH\ PD\ EH GLVFORVHG ZLWKRXW P\ FRQVHQW DV SHUPLWWHG E\ 0&/ DQG WKH 3ULYDF\ $FW RI 86& D IRU DOO DSSOLFDEOH URXWLQH XVHV SXEOLVKHG E\ WKH )%, LQFOXGLQJ WKH )HGHUDO 5HJLVWHU DQG IRU WKH URXWLQH XVHV IRU WKH )%,
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x I understand that intentionally making a false statement on this application is a felony punishable by imprisonment for not more than four years or a fine of not more than $2,500, or both. x , KDYH EHHQ SURYLGHG ZLWK D FRS\ RI WKH FRPSLODWLRQ RI WKH )LUHDUPV /DZV RI 0LFKLJDQ FUHDWHG E\ WKH /HJLVODWLYH 6HUYLFHV %XUHDX DQG IRUPV WR DSSHDO DQ\ QRWLFH RI VWDWXWRU\ GLVTXDOLILFDWLRQ RU VXVSHQVLRQ RU UHYRFDWLRQ RI D OLFHQVH XQGHU WKLV DFW Applicant's Name and Signature ,I FRPSOHWLQJ WKLV IRUP LQ SHUVRQ GR QRW VLJQ XQWLO LQVWUXFWHG E\ WKH FRXQW\ FOHUN RU KLV RU KHU UHSUHVHQWDWLYH 7KLV GRHV QRW DSSO\ WR renewal DSSOLFDWLRQV LI WKH FRPSOHWHG IRUP ZLOO EH VXEPLWWHG E\ PDLO RU HOHFWURQLFDOO\ 'DWH Witness’ Name, Title, and Signature ,I FRPSOHWLQJ WKLV IRUP LQ SHUVRQ WKH ZLWQHVV ZLOO EH WKH &RXQW\ &OHUN RU 5HSUHVHQWDWLYH $ ZLWQHVV VLJQDWXUH LV QRW QHFHVVDU\ IRU renewal DSSOLFDWLRQV LI WKH FRPSOHWHG IRUP ZLOO EH VXEPLWWHG E\ PDLO RU HOHFWURQLFDOO\ 'DWH When used as a new application, return the completed unsigned form and documentation of required training to the county clerk's office. A passport quality photograph must be submitted if a digital photograph is not on file with the Michigan Secretary of State.
Made with FlippingBook - professional solution for displaying marketing and sales documents online