Join the Citizens Academy

Join the Citizens Academy
Name*

First NameLast Name
DOB (mm/dd/yy)*

MonthDayYear
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Occupation
Employer
Employer Address

Street Address

Street Address Line 2

CityState

Zip Code
Business Phone
Please enter a valid phone number.Format: (000) 000-0000.
Drivers License Number*
Drivers License State*
Social Security Number*
YesNo
If Yes, please explain:
YesNo
If Yes, provide details of arrest(s) and/or conviction(s):
Please Provide one character reference, other than a relative, who has known you for at lease three (3) years.
Reference Name*

Reference First NameMiddle NameReference Last Name
Years Acquainted*
Reference Address*

Street Address

Street Address Line 2

CityState

Zip Code
Reference's Occupation*
Reference's Employer*
Reference's Home Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Reference's Business Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Reference's Email Address*
example@example.com
Do you have any special needs? (hearing impaired, etc.)
Please list any Citizens Academies you have attended in the past.
How did you hear about the Sheriff's Citizens Academy and why do you want to attend?
Please verify that you are human*
Should be Empty:

Please Provide one character reference, other than a relative, who has known you for at lease three (3) years.