Citizen Police Academy Application

HPD is now taking applications for the 2012 Academy, to be held September 10 - November 19, 2012.

Fill out the fields below, and then click on the "Submit" button at the bottom of the page.

* Denotes a required Field
Your full name: *
Gender: *
Birthdate: *
Street Number & Name: *
City: *
State: *
ZIP Code: *
Home Phone: *
Drivers License (or State I.D.) number: *
Social Security Number: *
Work or Cell Phone:
E-Mail Address:
Employer or Company: *
Have you ever been arrested for a non-traffic offense? *
If "Yes" or "Let me explain..." add comments an nature of convictions:
In your own words, why do you wish to attend the Citizen's Police Academy? *
For CPA Identification Card purposes, complete the following:
Hair color: *
Eye color: *
Height: *
How did you learn about HPD's Citizen Academy?
Agreement: Remember, by clicking the SUBMIT button below, you (the applicant) hereby certify that there are no willful mis-representations, omissions, or falsifications in the above statements and answers to questions. "I hereby authorize the Holland Police Department to secure criminal conviction history from the appropriate law enforcement agency, should the City determine it is necessary to do so." Notice: According to the Federal Freedom of Information Act, all messages received by the Holland Police Department become public record, subject to disclosure under the Act.
*	* I have read and agree to the above.
REMEMBER: All fields with an "*" are required!
* denotes required fields

Citizen's Police Academy