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2. Waiting List- Citizen Police Academy
4. First Name*
5. Phone Number *
7. Middle Name*
8. Email Address*
10. Last Name *
11. Date of Birth *

    MM/DD/YYYY

13. Address*
15. City*
16. State*
17. Zip Code*
19. Business Name (if applicable)
21. Business Address (if applicable)
23. City
24. State
25. Zip
27. Have you ever been arrested for an offense? *

    1. Yes
    2. No
29. If yes, please explain.
31. Shirt Size *

    1. Small
    2. Medium
    3. Large
    4. X-Large
    5. Other
33. Please review your answers carefully and read the statement below before submitting the application.

    "I hereby certify that there are no willful misrepresentations, omissions or falsifications in the foregoing statements and answers to questions. I understand that any omission or false statements on this application shall be sufficient cause for rejection of enrollment or dismissal from the West University Place Citizen Police Academy. I further understand that the West University Place Police Department will be conducting a thorough background investigation that may include, but is not limited to criminal history, driving record, photocopy of driver’s license and short interview. I also understand that any student may be removed from the West University Place Citizen Police Academy if said student is disruptive or otherwise brings discredit upon the concept of this program”

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35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

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