Citizens Police Academy Application

Name *

Street Address *

Address Line 2

City *

State *

Zip Code

Date of Birth

mm/dd/yyyy

License or ID number

Telephone number (Day)

Telephone number (Evening) *

Email address *

Are you a member of a Beat Management Team? *

Yes

No

Are you a member of a neighborhood council or civic association? *

Yes

No

Are you a member of a Crime Watch? *

Yes

No

List any other relevant organizations you belong to, if any.

How did you learn about this class?

Consent

I am submitting my name for consideration for admission to the Citizen's Police Academy. I understand that a record check will be conducted. I understand this is an educational opportunity. *