Citizens Police Academy Application

Citizens Police Academy

Application
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Add your best contact to reach you.
Alternative Phone Number
Add your best contact to reach you.
E-mail Address*
example@example.com
Date of Birth*

MonthDayYear
Date of Birth
Gender

MaleFemaleOther
Race
If you have any special needs that require accommodations to attend this program, please contact Monica at 954-346-1311.

Please review your answers carefully and read the statement below before signing this application.

I. {name15}, certify that there are no willful misrepresentations, omissions, or falsifications in the above statements and answers to questions.

I. {name15}, understand that any omission or false statements on this application shall be sufficient cause for rejection for enrollment or dismissal from the Coral Springs Police Department’s Citizens’ Police Academy.

I. {name15}, further give my consent to the Coral Springs Police Department to conduct a thorough background investigation that may include any criminal history, employment history, and personal references.
By typing my name in the below space, I am electronically signing this form. My signing this electronic signature certifies the information to be true, accurate, and complete.*

First NameLast Name
Should be Empty:

Citizens Police Academy