Chief of Police Youth Advisory Council Application

Chief of Police Youth Advisory Council

The Chief of Police Youth Advisory Council is a leadership development opportunity designed to bring together youth and law enforcement through conversations and community service. This program is made to boost the flow of communication with leaders of the Little Rock Police Department and local youth ages 14 -24. If you are interested, please complete the form below:
Youth Full Name

First NameLast Name
Youth Preferred Name
Youth E-mail
example@example.com
Youth Cell Number
Format: (000) 000-0000.
MaleFemalePrefer Not to Say
American Indian or Alaska NativeAsianBlack or African AmericanHispanic / LatinoNative Hawaiian or Pacific IslanderWhiteOther
Birth Date

MonthDayYear
Parent/Guardian Full Name

First NameLast Name
Parent/Guardian E-mail
example@example.com
Parent/Guardian Cell Number
Format: (000) 000-0000.
Permanent Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Education
Name of School or University
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Chief of Police Youth Advisory Council