Citizens' Police Academy Application
Name
Application Date
Email Address
Local Address

 

 Social Security Number
Date of Birth
Local Phone #

Driver's License (# and State)
Home Address

 

 Sex

  Male  Female
Shirt Size

(choose one below)
Home Phone #
 
 

Small  Medium  Large X-Large

Other:  

1.
What subjects are you most interested in learning about?
2. How did you hear about the Citizens' Police Academy?
Web Site Newspaper Friend Other:

3.
 
Have you ever been arrested or convicted of any crime?
 
Yes     No
 


I hereby submit this application and authorize the Northern Kentucky Police Department to conduct a background check for admittance to the Citizens' Police Academy:


Yes       No