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2. First Name
3. Last Name
5. Address
7. City
8. State
9. Zip Code
11. Phone Number
12. Email Address
16. Place of Employment
17. Title
19. Business Address
21. City
22. State
23. Zip Code
25. Work Phone
29. Education Level

    1. High School or Equivalent
    2. Some College
    3. Bachelors
    4. Graduate
    5. Other
31. Name of High School or College
32. City
33. State
35. Military Service
    -- Select One --YesNo
37. Branch of Service
38. Years of Service
42. Describe any specialized skills or training you have received:
44. Describe in detail why you want to participate in the Citizen’s Police Academy. Include: (A) What do you feel is the role of a police officer; (B) What aspects of law enforcement interest you; (C) What are some of the negative aspects of being a police officer; (D) How do you feel this experience will benefit you?
46. You must be able to pass a criminal background check in order to participate in this class

    1. I understand
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48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit Submit and Print

* indicates a required field