DA Academy Application

DA Academy Application
Applicant Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Birth Date*

MonthDayYear
Gender*
Email*
example@example.com
Driver’s License or CO ID #
Cell Phone
Home Phone
Occupation
Name of Employer / School
How long have you lived in Colorado?
EDUCATIONAL BACKGROUND: Please tell us about your educational background, including the highest level of education you completed:
HOW DID YOU LEARN ABOUT OUR CITIZENS ACADEMY?
*If other, please specify:
YOUR INTEREST: Why are you interested in attending the Citizens Academy? Please tell us one or two things you are hoping to learn by the end of this four-week academy.
IS THERE ANYTHING ELSE YOU’D LIKE TO INCLUDE (food allergies, requested accommodations, etc)?
Please answer yes or no to the following questions.

If you answer yes to any of the questions, please provide the date and court location as relevant. Additional space is provided below these questions for any additional information you would like to provide.
Are you currently serving as a Juror?*

YesNo
Have you received Juror Summons for a future date?*

YesNo
Have you served as a Juror in Larimer or Jackson Counties?*

YesNo
DO YOU HAVE ANY PAST ARRESTS, CONVICTIONS, OR PENDING COURT CASES?*

YesNo
If “Yes”, please list below the Date, Agency, Charge, and Outcome:
BACKGROUND AUTHORIZATION

I understand that a criminal background and warrant check will be conducted by the District Attorney’s Office (Eighth Judicial District) as part of the application process. I hereby authorize any law enforcement agency to release to the District Attorney’s Office, any and all information that said agencies may have about me, whether public, personal or confidential. I understand that I will not receive and am not entitled to know the contents of confidential reports received from these agencies. I hereby release, discharge, and agree to hold harmless the agencies, their agents, and any person furnishing information from any and all liability arising out of furnishing and inspection of such documents and information. I understand the District Attorney's Office reserves the right to exclude my participation in the academy and does not need to give me a reason as to why I was not selected. Preference will be given to Larimer and Jackson County residents and those applicants who have not previously attended the 8th J.D. District Attorney’s Citizen’s Academy.
SIGNATURE OF APPLICANT*

Clear
Date*

MonthDayYear
Date
Should be Empty:

DA Academy Application

Please answer yes or no to the following questions.

BACKGROUND AUTHORIZATION