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2. Last Name
3. First Name
4. Middle Initial
6. Address
8. City
9. State
10. Zip Code
12. Work Phone
13. Home Phone
14. Emergency Phone
16. Email
17. Date of Birth
    Date of Birth
18. Physical Condition

    1. Excellent
    2. Good
    3. Poor
20. Occupation
21. Place of Employment
23. Why do you wish to attend the Citizen's Police Academy?
25. Have you ever been arrested? If yes, what crime and when?
27. Give the name, address,a nd phone number of two character references:
29. Reference 1
31. Reference 2
33. Applicants are required to be at least 21 years of age and have no criminal record, (no felony convictions and/or arrests for Domestic Abuse Laws) because of firearms training that will take place during this course.
    
    Any questions about participating in or general questions about the Citizen’s Police Academy prior to submitting the application, please contact Officer Gene Page at 479-271-6200 or via email.
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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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