Community Police Academy Registration Form

MCPD Community Police Academy Registration Form

Fill out the entire form carefully to be considered. The application deadline is July 15th. Acceptance or denial emails will be sent out by August 1st.
Must be 18 or older to apply

*** Participants cannot miss more than 2 sessions ***
Sessions Include

9/10, 9/17, 9/24, 10/01, 10/08, 10/15, 10/22
Name

First NameMiddle Name (If no middle name put n/a)Last Name
Address

Street Address

Street Address Line 2 (If none put n/a)

CityState / Province

Postal / Zip Code
Phone Number
Format: (000) 000-0000.
Gender
Race
Age
Social Security Number
Needed for the background check
Driver's License Number
Driver's License State
E-mail
example@example.com
If you're a Manassas City Business Owner please specify which business. (If not applicable put n/a)
Employer's Name
If no put n/a
Employer's Address (If none put n/a)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer's Number
If none put n/aFormat: (000) 000-0000.
Occupation/Job Title
If none put n/a
Have you ever been arrested/detained for an offense other than a traffic violation?
If yes, state where, when, and describe the circumstances.
Have you ever been arrested or convicted of any misdemeanors or felonies?
If yes, state where, when, and describe the circumstances.
Have you ever been arrested or convicted of domestic violence?
If yes, state where, when, and describe the circumstances.
Describe in your own words why you want to attend the MCPD Community Police Academy.
Emergency Contact Name

First NameLast Name
Emergency Contact Number
Format: (000) 000-0000.
Emergency Contact Relationship
I hereby authorize the Manassas City Police Department to make an examination of the records available to the Manassas City Police Department for the purpose of evaluating my application and allowing participation. ***Records checks will include but not limited to Criminal History Report (CCH),local checks via police databases, and Driver's License Query/transcripts.
Additonal Comments
Should be Empty:

MCPD Community Police Academy Registration Form

Must be 18 or older to apply

Sessions Include