Last Name:

First Name:

Middle Name:

Address:

City:

State:

Zip Code:

Phone Day:

Phone Eve:

Date of Birth

E-Mail:

Occupation:

US Citizen:

Academy Requested:

Why do you want to attend an LVMPD Citizens Academy?

How did you hear about the Citizens Academy?

Have you ever used
illegal substances?
If yes explain:

Have you ever been arrested/convicted of a crime? If yes explain:

What time of the year would be best for you?