Moorhead Police

- Volunteer Program
- Crime Free Multi-Housing
Program
- Neighborhood Block Club
- Night to Unite
- Senior Safety - TRIAD
- Citizens Police Academy

Citizen's Police Academy Application

The information you provide on this application will be used for consideration of your attendance at the Citizen’s Police Academy and for no other reason.

	First Name:
	Middle Name:
	Last Name:
	Date of Birth:
	Address:
	City:
	State:
	Zip:
	Home Phone:
	Work Phone:
	Cell Phone:
	Email Address:
	Shirt Size:

	Drivers License #:
	State Issued:

	Employer:
	Occupation:
	Employer's Address:
	City:
	State:
	Zip:

	Contact Name:
	Address:
	City:
	State
	Telephone Number:
	Relationship


	Have you ever attended a Citizen's Police Academy of any kind in the past?			Yes No

	If yes, which one?


	Have you been arrested for any offense other then traffic violations?			Yes No

	If yes, What for ?

	When?

	Where?


	List/Describe any civic activities or organizations you are involved in:


	What experience have you had with law enforcement?			Positive Negative

	Briefly Explain


	Why are you interested in the Citizen's Police Academy?


	What do you expect to gain from attending this academy?

I UNDERSTAND THAT SPACE IS LIMITED, ALLOWING ONLY 24 STUDENTS TO PARTICIPATE IN THE CITIZEN’S POLICE ACADEMY. THEREFORE, I AGREE TO ATTEND AT LEAST EIGHT OF THE 10 SCHEDULED SESSIONS. ADDITIONALLY, I AGREE TO ARRIVE PROMPTLY AND TO COMPLETE AND RETURN THE EVALUATION FORM PROVIDED FOR EACH SESSION.

I HEREBY CERTIFY THAT THE INFORMATION CONTAINED IN THIS APPLICATION IS TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. YOU ARE HEREBY AUTHORIZED TO MAKE ANY INVESTIGATION OF MY PERSONAL HISTORY DEEMED NECESSARY FOR CONSIDERATION TO ATTEND THE CITIZEN POLICE ACADEMY.

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