CPA Application Please complete this form to be considered for the upcoming Citizen Police Academy. We welcome all ages and abilities. Must be 18 years old / no felony convictions. Please enable JavaScript in your browser to complete this form.Application Date *Name *FirstLastBirthday (type: mm/dd/yyyy)Drivers License Number *Social Security Number *Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Email *Have you ever been investigated, cited or arrested for a crime other than a traffic offense? *YesNoIf Yes, please explain – If no, insert N/A *Do you currently or have you previously had a Domestic Violence Order against you? *YesNoIf Yes, please explain – If no, insert N/A *Has your operator license been suspended? *YesNoIf Yes, please explain – If no, insert N/A *Have you been arrested for a traffic offense? *YesNoIf Yes, please explain – If no, insert N/A *Do you have a CCDW Permit? *YesNoIf Yes, please explain – If no, insert N/A *Do you have any special needs that require accommodations in order for you to participate in this program? *YesNoIf Yes, please explain – If no, insert N/A *Do you have any allergies that we need to be aware of? *YesNoIf Yes, please explain – If no, insert N/A *Why are you interested in attending the Citizen Police Academy? *Please list community involvement, activities, associations, or organizations in which you participate: *Reference 1 – List three character references that are not family members or employers *FirstLastReference 1 – Phone Number *Reference 2 *FirstLastReference 2 – Phone Number *Reference 3 *FirstLastReference 1 – Phone Number *Please provide any additional information you think we need to know:Please Read Before Submitting This Form I hereby certify that there are no willful falsifications, omissions, or misrepresentations in the foregoing statements and answers to the questions. I understand that any omission or false statement on this application shall be sufficient cause for rejection for enrollment or dismissal from the Georgetown Police Department Citizen Police Academy. I also grant permission for the Georgetown Police Department to verify the above information contained on this application and check for prior criminal history. CheckboxesI consent to having this website store my submitted informationPhoneApply to Georgetown CPA