CPA APPLICATION

DCPD CITIZEN POLICE ACADEMY

Please fill out and sign the CPA enrollment and authorization for release form and click submit. We thank you for your interest in the Citizen’s Police Academy!
APPLICATION

Applicants must be at least 18 years of age. Incomplete, inaccurate, or unsigned applications and anyone having charges currently filed against them that are either being tried or pending, in any criminal court will not be considered. The CPA meets once a week on Tuesday evenings from August 20th - October 22nd from 6:30 pm to 9:30 pm at the Kansas Law Enforcement Training Center located at 236 San Jose Dr., #17 (Hennessy Building, main level) in Dodge City. The course consists of 10 sessions and one optional session on a Saturday “Range Day.” A graduation ceremony and refreshments is provided on the last night of the CPA.
Personal*

First NameLast Name
Street Address

Mailing Address

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Date of Birth*
Driver's License # & State*
E-mail (we will email class confirmation)*
example@example.com
College Graduate?*

YesNo
Degree/Major
Business/Employer Name
Job Title
Please Explain Briefly Why You Wish to Enroll in the DCPD's Citizen Police Academy.*
Do you have any charges filed against you that are currently being tried or are pending in any criminal court?*

YesNo
Have you ever been convicted for any offense other than a traffic violation?*

YesNo
If yes, state where, when, and describe the circumstances. If no, type "N/A"*
I hereby authorize the Dodge City Police Department to make an examination of my Criminal History Record Information for the purpose of evaluating my application.*

Yes
Is there any Medical Information you Feel the DCPD Should be Aware of?
Name of Emergency Contact*

First NameLast Name
Phone Number of Emergency Contact*
Please enter a valid phone number.
Were you Recommended or Advised to Apply to the Citizen Police Academy?

YesNo
If so, By Whom?
I hereby certify that there are no willful misinterpretations, omissions, or falsifications in the foregoing statements and answers to questions. I understand that any omission or false statements on this application will be cause for rejection for enrollment, or dismissal from the Dodge City Police Department's Citizen Police Academy. I understand that a rejection of enrollment may occur if I have any charges filed against me that are currently being tried or are pending in any criminal court. I understand that there is no charge for the academy, and if selected for enrollment, I pledge the time commitment to attend.
Signature*

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DCPD CITIZEN POLICE ACADEMY

APPLICATION