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Citizens Police Academy Registration Form

First Name

   Mid            Last Name                                             DOB
Street Address                City
                       State                       Zip Code
Home Telephone Work or Cell Phone             E -mail  
Emergency Contact Name        Phone Number
Can you fulfill the commitment to attend all classes for the duration of the Citizen Police Academy?    Yes    No
  Why do you wish to participate in this program?

What , if any, is the extent of your involvement in the community? (Clubs, Social Groups, etc..)

Is there a Law Enforcement topic, of interest, that you would like to be included in the Citizen Police Academy?



I hereby make application for the Citizen Police Academy hosted by the New Rochelle Police department.

I understand that a standard background check will be conducted using the information I have provided.

I understand that all obtained information will be confidential.

All information is accurate to the best of my knowledge.

You will be required to sign this document prior to attending the Citizens Police Academy.

I have read and I do understand the statements above.


You will be sent to the NRPD Home page after submission.



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