Citizens Public Safety Academy Application

Please complete the following form and upload proper identification to be considered for the Citizens Public Safety Academy Program.

If you submit your form electronically and are unable to get it notarized, it can be notarized at the Police Department on the first night of the academy.

Supporting Documents

Release Assumption Agreement (611 KB)

Liability Form (6 KB)

form.antibot { display: none !important; } You must have JavaScript enabled to use this form.

Name *

Phone Number *

Date

edit-submitted-date-month

edit-submitted-date-day

edit-submitted-date-year

Address *

Date of Birth *

Drivers License State/ Number *

Business Address

Business Phone *

Occupation *

Cell Phone Number *

Email Address *

Have you ever been arrested? If "yes" please give specific details (i.e. Where, Date and Why) *

I understand by enrolling in the citizen public safety academy, I am subject to a background check which includes a check of any arrest record, driving record and/or other criminal history. (Please type your full name and today's date) *

Please give the name, address and phone number of two character references: *

Please Upload Completed Indemnification Agreement *

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png txt pdf doc docx.

Please Upload Colored Photograph *

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf doc docx.

Please Upload Photo of ID *

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png eps pdf doc docx.