Clone of MPD YPA 2025

2026 Youth Leadership Academy Application
Youth Leadership Academy Dates
- Week #1 - July 27-31, 2026 - Boys Week
- Week #2 - August 3-7, 2026 - Girls Week
Age Requirements: Youth 13-16 years old

For questions or more information, please reach out to Master Sargent Saunders at SSaunders@Middletown.Delaware.Gov or (302) 376-9950.
Applicant's Information (Youth)
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Age
Date of Birth
Social Security Number
Grade (2024-2025 School Year)
T-Shirt Size (Adult Sizes)
Basketball/Gym Shorts Size (Adult Sizes)
Portions of the Middletown Police Department Youth Academy are made possible from the use of federal funds. The following demographics will be documented anonymously for federally funded reporting requirements.
Applicant's Gender
Applicant's Race
Applicant's Ethnicity

Youth Applicant's Medical Information

To be filled out by a parent/guardian.
Has the applicant had a physical within the last year?
When was their last physical?

MonthDayYear
Date
When is the last time the applicant saw their family or primary care physician?

MonthDayYear
Date
Who is the applicant's family or primary care physician?
Applicant's Height
Applicant's Weight
Applicant's Statement of Health
Please list the applicant's current medications. Please include any over-the-counter medications as well. If none, please type N/A.
NOTE: Prescription medications taken during Academy hours must be accompanied by a note signed by the prescribing doctor. It must include drug information, specific dosage, and any special instructions. All OTC medications must be reported to the Officer in Charge and must have detailed instructions for dosage. These must be accompanied by a detailed note signed by the parent/guardian. Youth are not permitted to hold or administer any medications to themselves without the knowledge of the Officer in Charge on a daily basis.
Please list the applicant's know allergies. If none, please type N/A. Medications associated with allergies must be listed with the prescription medications below:
Does the applicant:
Does the applicant have any disabilities?
Please explain disabilities.
Other information or conditions that the Academy Staff should be aware of?
Health Insurance Information
Company Name
Subscriber
Subscriber ID#
Account #

Personal References

Please list 3 references for the applicant
Reference 1's Name

First NameLast Name
Reference 1's Email
example@example.com
Reference 1's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference 1's Relationship to Applicant
Reference 2's Name

First NameLast Name
Reference 2's Email
example@example.com
Reference 2's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference 2's Relationship to Applicant
Reference 3's Name

First NameLast Name
Reference 3's Email
example@example.com
Reference 3's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference 3's Relationship to Applicant

Additional Information

To be completed by the applicant
Why do you want to participate in the Middletown Police Department's Youth Academy?

Disclaimer and Signatures

To be completed by both parents/guardians and the youth applicant
I certify that my answers are true and complete to the best of my knowledge.

I understand that my application will be reviewed and there are a limited number of participants. The Middletown Police Department follows equal opportunity guidelines and the decisions of those individuals that are selected are made final by the Chief of Police. Any individual that is not selected is eligible and encouraged to reapply for a Youth Academy that may be held in the future.
Youth Signature
Type Name
Parent/Guardian Signature
Type Name
LEGAL GUARDIANS MUST PROVIDE COURT DOCUMENTS. IF PARENTS HAVE JOINT CUSTOY, BOTH PARENTS MUST SIGN ALL FORMS OR PROVIDE WRITTEN PERMISSION FOR THE APPLICANT TO ATTEND THE ACADEMY.
Type Name
Should be Empty:

2026 Youth Leadership Academy Application