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Young Citizen Police Academy (YCPA) Application

2. You must be 18 years or older to complete or submit this application.

   You must be 18 years or older to complete or submit this application.

4. First Name*

5. Last Name*

7. Address1*

9. City*

10. State

11. Zip

13. Parent or Guardian*

14. Email Address*

16. Home Phone #*

17. Emergency Contact #*

18. Date of Birth*

20. Drivers License # and State *

21. Have you ever been convicted of a crime?*

    1. YES
    2. NO

22. Explain

24. Character Witness #1*

    Name & phone #

26. Character Witness #2*

    Name & phone #

28. In consideration of my application to attend the YCPA, I give the Lake Jackson Police Department permission to check my personal background, references and to conduct other background checks as necessary to insure the integrity of the class.

    In consideration of my application to attend the YCPA, I give the Lake Jackson Police Department permission to check my personal background, references and to conduct other background checks as necessary to insure the integrity of the class.

29. Permission*

    1. YES
    2. NO

31. YCPA Information

    YCPA

Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field