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Citizens' Police Academy

First Name:

Middle Name:

Last Name:

Home Address:

Home Phone:

Business Address:

Driver's License #:

Date of Birth:

Have you ever been arrested for any criminal offense?
YesNo

List person to be contacted in case of an emergency,including address and phone #:

Are you willing to sign a waiver of liability in order to participate in a police ride-along program?
YesNo

I hereby certify that the information contained in this application is true and complete to the best of my knowledge. Members of the East Lansing Police Department are hereby authorized to make any investigation of my personal or criminal history deemed necessary for consideration to attend the Citizen's Police Academy
YesNo

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