Citizen's Academy Program Application

Last Name First Name Middle Name
Address City Zip Code
Home Phone Cell Phone Date of Birth
Company Name Occupation Work Phone
List any health problems that might limit your physical participation in the Citizen’s Academy program

Are you able to make an eight week commitment to attend Citizens Academy?
Have you ever been convicted of a criminal offense?
If yes, please explain

Please tell us something about yourself

Email Address
NOTE: A criminal history background check will be done on every applicant prior to being accepted into Citizens Academy.
*If you have any questions or concerns, please contact us at 801-229-7075.