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Citizens' Police Academy Application

Please correct the field(s) marked in red below:

Application 

Start Date: Thursday, September 19, 2019

Class 10/31 will be held on Wednesday, 10/30

End date: Thursday, November 20, 2019

Hours: 6:00 p.m. - 9:30 p.m.

Classroom Instruction -10 Weeks

No charge to attend

 

 

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Costa Mesa Police Department


1
Name:
 *
2
Birth Date:
 *
3
Home Address:
 *
Home Address:
4
Work Address:
 *
Work Address:
5
Telephone:
Telephone:
6
Drivers License
 *
Drivers License
7
Occupation:
 *
8
E-mail Address (your email address will only be used to communicate information about Citizens’ Police Academy and will not be distributed otherwise. )
 *
E-mail Address (your email address will only be used to communicate information about Citizens’ Police Academy and will not be distributed otherwise. )
9
Desired Name or "Nickname" (Spelling for Name Tags):
 *
10

I consent to a criminal records check and will provide a fingerprint card (taken by CMPD at no cost) to determine eligibility for the Costa Mesa Citizens’ Police Academy. If accepted as a student, I agree to abide by all rules and regulations, to have no more than one absence, and to be on time during the 8-week class schedule.


11
Applicant's Signature Date:
 *
12
How did you hear about our Citizens Academy?
 *
  1. To receive a copy of your submission, please fill out your email address below and submit.