Citizens Police Academy Application "*" indicates required fields Personal InformationName* First Last Address* Street Address Address Line 2 City ZIP Code Email* Cell Phone #Home Phone #Work Phone #Drivers License Number#* Driver's License State* AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Date of Birth* MM slash DD slash YYYY Emergency Contact Name* Emergency Contact Phone*Law Enforcement ExperiencesHave you ever been arrested for an offense other than traffic?* Yes No Please explain*What Experience have you had with law enforcement?* Positive Negative None Please explain:*Citizen Police Academy InformationHow did you hear about the Citizens Academy?*This program requires the attendance of eleven 2 1/2-hour class periods on Thursday evenings, 6-8:30 PM, from Sept. 8, 2022, through Nov. 17, 2022. Do you anticipate being able to attend all of the classes?* Yes No Attendance* I acknowledge 3 or more absences may result in removal from the program.In a few lines explain why you want to attend Greeley’s CPA.*Electronic Signature - Please type your name* I CERTIFY THAT THE INFORMATION IN THIS APPLICATION IS TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I ALSO GRANT PERMISSION FOR THE GREELEY POLICE DEPARTMENT TO VERIFY THE ABOVE INFORMATION CONTAINED ON THIS APPLICATION AND CHECK FOR PRIOR CRIMINAL HISTORY.PhoneThis field is for validation purposes and should be left unchanged.