Academy Application

ACADEMY APPLICATION

Release of Liability PDF

Health Form PDF

Please complete the following information form and submit.

Last Name

Middle Name

First Name

Street Address

City

State

Postal / Zip code

Phone

Driver's License Number

Alternate Phone

Date of Birth

SSN

Height

Weight

Emergency Contact

Emergency Contact Last Name

First Name

Street Address

City

State

Postal / Zip code

Phone

Alternate Phone

Relationship

Agency Point of Contact Information

Name of Agency

Rank

Last Name

First Name

Street Address

City

State

Postal / Zip code

Agency Phone

Agency Fax

Point of Contact Email

Trainee Date of Hire

Military Service History (leave blank if it does not apply)

Branch/Rank

Dates of Service

MOS

Medical Information

Date of last physical

Doctor Name

Doctor Phone

List medical issues or medications which may cause issues during training (allergies)

Academy Session Status

Select Appropriate Box

POST Basic Level 1 - Full Time $850

POST Level 2 to 1 Transition - $400

POST Corrections Level 3 to 2 Transition - $400

POST Corrections Level 3 (92 hour) - $250

POST Refresher - $250

Trainee Name

Division Head Name

Upload Release of Liability

Upload File

Upload Health Form

Upload File

Thanks for submitting!