Form Page: Citizens

MECKLENBURG COUNTY SHERIFF'S OFFICE

CITIZENS' ACADEMY REGISTRATION FORM

First Name

MI:

Last Name:

Suffix:

Preferred Name:

Street Address:

City

State

Zip

Primary Contact

Secondary Contact

Email:

Birth

Month

Day

Race:

Gender:

US Citizen:

Yes

Law Enforcement Experience

Yes

Drivers License Number:

Occupation:

Employed

Retired

Student

Others

Previous Applied?

How did you hear about Citizens Academy:

T-Shirt Size:

Reason for Attending:

Note: A criminal background check will be performed due to law enforcement sensitivity issues. By submitting this form you grant permission for the Mecklenburg County Sheriff's Office to conduct a standard background check of you.