2. Session*

   Please specify which session you want to attend.

   1. Spring 2016 (Wed Nights / Jan 20 - Apr 20)
   2. Spring 2017 (Dates to Be Determined)
4. First Name*
5. Last Name*
7. Address*
9. City*
10. State*
11. Zip*
13. Email Address*
15. Date of Birth*
    Date of Birth
17. Primary Phone*
18. Secondary Phone
20. Employer*
22. Drivers License No.*
23. Drivers License State*
25. Are you a taking the CPA for college credits?*

    1. Yes
    2. No
27. What school are you attending?

    1. Mt. Marty College
    2. Lake Area Technical Institute
    3. Other
29. Please list the "Other" school*
31. Have you been arrested for, or convicted of, a felony?*

    1. Yes
    2. No
33. Please provide the offense(s) and the approximate date(s)
35. Have you been arrested for, or convicted of, a misdemeanor (excluding Class II traffic offenses)?*

    1. Yes
    2. No
37. Please provide the offense(s) and the approximate date(s)
39. Agreement
    I agree to submit to the WPD’s selection process and understand that I must successfully complete this process before being given final consideration for acceptance. I understand that the Watertown Police Department reserves the right to deny entry into the Citizens’ Police Academy based on the findings of a background check. I understand that the WPD may take photographs and/or videos of Academy sessions. I hereby consent to having my photograph and/or video image used in future promotional materials. I certify the information contained on this form is true and accurate, to the best of my knowledge. I realize that falsification or misrepresentation on any portion of the application packet may result in my not being accepted into the Citizens’ Police Academy.
41. Certification

    1. Yes, I agree to the above terms
    2. No, I do not agree
Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

* indicates a required field