Winston-Salem Police Department

Citizen's Police Academy
Application For Enrollment Spring 2012
Classes are March 29 through June 28 (13 weeks, skipping the week of May 6)

**Deadline to apply is March 8, 2012 **

The ultimate goal of the Citizen Police Academy (CPA) is to educate the citizens of Winston-Salem about the operation of their police department while obtaining valuable feedback from those citizens.  The academy is NOT designed to train participants to become police officers.

Applicants for the academy's 13-week educational awareness program must meet 3 basic requirements:

1. Must live, work, or attend school in Forsyth County.
2. Must be 18 years of age or older.
3. Must not have a criminal history (a background check is performed).

Please see our Frequently Asked Questions [pdf/92kb/3p] for more details.
Applications are also available for download [pdf/100 kb/3p]

Please mail any completed paper applications to:
Winston-Salem Police Department
Att: Officer J.R. Lewis/CPU
725 N. Cherry Street
Winston Salem, NC 27101

***All fields must be completed.     

Name:      
           Last                            First                             Middle
        
Race:     Sex:      Date of Birth:     Age:

Address

Street: City:  State: NCALAKASAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

Zip Code:

Home Phone:               Cell Phone:  
                  Ex:(xxx)xxx-xxxx                                 Ex:(xxx)xxx-xxxx

Driver's License Number:      State: NCALAKASAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

E-Mail Address:

Do you live, work, or go to school in Winston-Salem?  YesNo  

Education
High School Graduate: YesNo   GED: NoYes 

Name of School:   
School Address:

College Graduate: YesNo 
Degree(s)/Major(s):   
                             
                             

Name of College:    
Address of College:  

Background
Please explain why you wish to enroll in the Winston-Salem Police Department
Citizen's Police Academy.

Do you have any special needs that require accomodation in order for you to
participate in this program?

Have you ever been arrested for, convicted of, cited for an offense
(including DWI), other than traffic fines of $200 or less?
***A thorough background check will be conducted to determine 
      suitability for admission to the program.


Have you been fired or asked to resign from any job in the past
five years? NoYes

If yes, please explain:
 

Employment
List information on your current or most recent job held:

Present Employer:
Address:
Position/Title:
Date Employed:
Business Phone:  
Supervisor:

Emergency Contacts
List two immediate family members or close friends we may contact in the event
of an emergency:

1. Name:  
   Home Address:
   Home Phone: 
   Business Address:
   Business Phone:

2. Name:
   Home Address:  
   Business Address:
   Business Phone: