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Today is Sunday, July 21, 2024.
Citizens Police Academy Application

Please fill out the information below.

* Information is required.

* Name:
* Address:
* Email
* Telephone Number:
* Work Number:
* Driver's License Number:
* Date of Birth:
* Place of Employment & Occupation:
* Address:
* Have you ever been arrested or convicted of any criminal offenses?

If yes, please explain:
* Shirt Size:
* In consideration of the acceptance in the program, I authorize Miami Township to use my photograph or other image for any purpose.

I authorize Miami Township to conduct an investigation into any Traffic or Criminal convictions that I have. I understand that this background investigation is being conducted as part of Miami Township Police Department's consideration of my application for participation in their Citizen Police Academy and that the results thereof will be utilized for purposes of determining my eligibility to participate.

I have read the Miami Township Police Directive 16.4, Auxiliary Programs | LINKED HERE | I have read and understand it and agree to comply with its provisions. Do you authorize and agree?

Attach a Picture or File (max size: 30MB):
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* Information is required.

No changes my be made to form without authorization of the Assistant to the Chief of Police

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

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