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2. First Name*
3. Last Name*
5. Date of Birth
   Date of Birth
7. Race*

   1. American Indian
   2. Asian
   3. Black
   4. Hispanic
   5. White
   6. Multicultural
   7. Unknown
9. Sex *

   1. Male
   2. Female

   (Needed to complete required criminal background check)

11. Address*
13. City*
14. State*
15. Zip Code*
17. Primary Phone*
19. Secondary Phone
21. Email Address*
23. Do you have a Denison address or work in the city of Denison?*

    1. Yes
    2. No
25. How did you hear about the academy? *
27. Please explain briefly why you want to attend the Citizens Police Academy:*
29. Have you ever been arrested for, convicted of, or cited for an offense other than a traffic violation? *

    1. Yes
    2. No
31. Have you been a party of a civil lawsuit in the past ten years? *

    1. Yes
    2. No
33. If you answered yes to the previous question, explain the details including charges, places, actions taken, etc.:
35. Present Employer *
36. Date Hired *
    Date Hired
38. Occupation *
39. Job Title *
41. Address*
43. City*
44. State*
45. Zip Code*
47. May we place your name, address, and phone number on a class roster? *

    1. Yes
    2. No

49. 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 statement on this application shall be sufficient cause for rejection of enrollment or dismissal from the Denison Citizens Police Academy. I understand that participation in this program is not to train students to be police officers. Participation is to provide education regarding the purpose, rationale and context of police procedures. I acknowledge that as part of acceptance in this program, I will be required to attend at least 70% of the classes. Failure to attend will be cause for dismissal from this program. I will abide by all rules and regulations set forth by the Denison Police Department and the City of Denison and will provide my own transportation and insurance. I further understand that the Denison Police Department will conduct a thorough background investigation that may include criminal history information, employment history and personal references. The Denison Police Department reserves the right to deny any applicant.

51. Terms*

    1. I Agree

    By selecting 'I Agree' you acknowledge that you have read, understand, and agree to the previous statement.

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53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit

* indicates a required field