CITIZENS POLICE ACADEMY APPLICATION
Name:
Address:
City:
State:
Zip:
Phone Number:
Email:
Date Of Birth:
Race:
Sex:
Social Security #:
In What Neighborhood Do You Reside?
Place Of Employment:
List Any Organizations In Which You Are Involved:
Please Tell Us How You Found Out About The Program:
Through A Friend
Newspaper
Television
Radio
Magizine
Social Media
Other
SPECIAL NEEDS/REASONABLE ACCOMMODATION: Please indicate any special needs
you may have due to an ADA handicap:
Please include a brief statement as to why you wish to participate in the Citizens Police Academy:
A confirmation letter and a map will be sent to you upon approval.