National Night Out
D.A.R.E. Golf Scramble
Coffee With A Cop
Name (You must be 18 or older to apply.)
Date of Birth mm/dd/yy
Cell Phone #
Home Phone #
Work Name & Occupation
Emergency Contact (Name & Phone #)
A Criminal Background record check is required of all those attending the Citizens' Police Academy. The following information is required to perform this check. (Please check all boxes that apply.)
1. How did you hear about the Citizens' Police Academy?
2. Have you ever had any contact with the London Police Department? If so, how was your experience?
3. Have you ever been arrested for a felony or misdemeanor?
If you answered "yes" to the question above, please provide details, if no, proceed to the next question
4. Can you commit to attending all classes for the duration of the Academy?
(Please note that all students missing more than one (1) evening of instruction will be dropped from the Academy. If you have other priorities at the present time, please do not submit an application to attend at this time.)
5. Why do you wish to participate in the Citizens' Police Academy?
Signature: (Type name as you would sign it.)
I hereby certify that there are no willful misrepresentations, omissions, or falsifications in the foregoing statement and answers to questions. I understand that any omission or false statement on this application shall be sufficient cause for rejection of enrollment or dismissal from the London Police Department's Citizens' Police Academy. I understand that participation in this program is not to train citizens to be police officers. Rather, the goal and purpose of this program is to educate citizens regarding the purpose, rationale and context of police procedure. I acknowledge that as part of acceptance to this program, I will be required to attend at least 8 of the 9 classes. Failure to attend will be cause for dismissal from graduating. I will abide by all rules and regulations set forth by the London Police Department and the City of London, Ky. I will provide my own transportation when required. I further understand that the London Police Department will be conducting a thorough background investigation. By clicking "Submit", you are confirming that you have read and agree with the terms and conditions of the Academy. No personal or private information will be shared.