EmailMe Form - Brunswick Citizen's Police Academy

Please fill out the requested information below. If you choose to print out this form, please type or print the requested information. Your Social Security number may be required to facilitate the completion of the required background check. Any felony convictions will be cause for denial. You must be 18 years of age to apply. All applicants must be available to attend classes that will be scheduled on a weeknight from 6:00-9:30 pm. You do not need to live or work in the City of Brunswick to apply; however first preference will be given to those who do.

Name *

First Last

Date of birth *

MM / DD / YYYY

Home phone *

### - ### - ####

Work phone

### - ### - ####

Address *

City *

State *

ZIP code *

Employer *

Position *

Email *

Please attach a short paragraph stating why you are interested in attending the Citizen's Police Academy. Include special interests or talents that you believe would help fellow classmates and other citizens. The paragraph must be included for the application to be considered.

The undersigned applicant understands and agrees that the Brunswick Division of Police reserves the right to deny entry to the academy based on the findings of the background check, needs of the class and space for attendees. You will be notified by phone if your application is accepted for enrollment.

Applicant signature _________________________________________

Date _____________________

Your signature on this document indicates that you are aware of requirements and that you agree to complete a Request to Observe Operation form, thus releasing the City of Brunswick from certain liabilities.

Please mail completed application to:
Brunswick Division of Police
Attn: AnnMarie Jones
4095 Center Road
Brunswick OH 44212

You may also e-mail your completed application by filling the CAPTCHA field at the bottom and clicking the SEND button.

Paragraph *