Name First Middle Last Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email Enter Email Confirm Email PhoneBirth date MM slash DD slash YYYY Time commitmentAttendance at all sessions is mandatory.Are you able to make this time commitment to the Academy? Yes No Do you have reliable transportation (and backup transportation if you have car trouble)? Yes No If you have children, do you have reliable child care (and backup child care if needed)? Yes No NA Background checkYou must have a clean criminal record to enter the Law Enforcement Academy (excluding most misdemeanors and traffic offenses).Do you have any felony charges, domestic violence charges, or drug offenses on your criminal record, including juvenile offenses and expunged offenses?The FBI background check shows ALL offenses. Yes No Do you have any protection orders filed against you? Yes No Physical fitnessDo you have any physical or medical conditions that might limit your ability to participate in exercising, running, jumping, wrestling, driving, and other physically demanding activities? Yes No Please explain your medical condition.Can you meet these physical fitness standards (see below) at this time? This level of physical fitness is required for admission into the academy. Yes No When would you like to start the academy?not sureFallSpringSummerCommentsThis field is for validation purposes and should be left unchanged.