Citizens' Police Academy Application
Name:
Address:
City:
State:
Zip:
Home Phone:
Date of Birth:
E-mail address:
Driver's License No.:
Employer:
Work Phone:
Business Address:
Occupation:
List community, neighborhood, or civic group affiliations
How did you hear about the Citizens' Police Academy?
Why do you want to attend?
Select One
This form can be submitted via email to the City	This form can be submitted to a PDF that you may print and mail to the city Adobe Acrobat is Required