E-Gov Services City of Mt. Juliet

Citizen's Police Academy Application

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Purpose. Our next Police Academy will be held XXXXXX. This form is used to communicate with Mount Juliet Police personnel and request information regarding application to the Citizens Police Academy. You will be notified if you are accepted into the CPA.

* Information is required.

Contact Information

* First Name:
* Last Name:
Email:
* Daytime Phone:	() –
* Address:
* City:
* State:
* ZIP:

Mobile Phone

Other Phone

* Drivers License #

Employer

Employer Address

Employer City

* Emergency Contact

* Emergency Contact Phone #

* Please list any associations, clubs, or organizations you are affiliated with:

* We supply our students with complimentary shirts for the class. Please select the size you would like us to order for you.

Small

Medium

Large

X-Large

XX-Large

Check here to have email confirmation of this request sent.

* Information is required.

Notes:

If you send us a message, you'll receive a Tracking Number allowing you to follow-up with your request, at your convenience.

Information we receive may be considered public information which is subject to disclosure under current state law. Learn more about our Privacy Policy.

Internal Use Only, Leave Blank:
Please leave this field blank and remove any values that have been populated for it.