Name:
Address:
City:    State:    Zip:
Phone:    E-Mail:
Drivers License#    DL State:   

Employer:
Address:
City:    State:    Zip:
Phone:    E-Mail at work:

Have you ever been convicted of a crime?    Yes    No

Do you have any physical limitations or medical condition that would keep you from participating in this training?    Yes    No
If yes, please explain (this may not keep you from attending the academy)

This academy will meet one night a week from 6:30 pm to 9:30 pm for 6 weeks and two Saturday sessions.  Due to the nature of this training, it is important that you attend each training session.  Can you commit to the training each week?    Yes    No

Shirt size:    Small    Medium    Large    X Large    XX Large    XXX Large

Please submit your COMPLETED application by pressing the submit button.  You will be contacted by Lt. David Townsend when you application is received.  If you have any questions, please contact Lt. David Townsend at 901-457-2560.  The dates of the next class is listed on the main Citizen's Police Academy web page.