Community Academy Application

Community Academy Application



Date of Birth*

Drivers license number*

Home Phone Number*

Alternate Phone Number

Email Address*


Emergency Contact*

Have you ever been arrested, detained or charged with a crime including criminal traffic offenses?*

Why do you wish to atend the Des Moines Citizens Academy?

Photographs may be taken during the Des Moines Citizens Academy session and may be used in printed and electronic promotional materials. Do you give the City of Des Moines and the Des Moines Police Department permission to use photos of you?*

As an applicant for the Des Moines Police Department Citizens Academy, I hereby authorize the Des Moines Police Department to conduct a criminal history check, including convictions, pending charges and outstanding warrants. I understand that this criminal history check is being conducted due to the nature of the classes given at the Citizen Academy.

I understand that all available records will be checked and that the information will be used in determining eligibility of applicants for the Citizens Academy. State and Federal law mandates that information provided by the criminal background shall be confidential and shall not be disclosed to third parties.

Applicant Signature*


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Email address

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