CMPD

601 East Trade Street Charlotte, NC 28202

CMPD Youth Academy Enrollment Application

Enrollment to this Academy

Enrollment into this Academy

Applicant Information

Last Name

First Name

Nicknames or Aliases

Age

Race

Sex / Gender

Male

Female

Home Address

City

State

Zip Code

Email Address

Home Phone Number

Mobile Phone Number

High School Attending

Current Grade Level

School Resource Officers SRO Name

SROs Email Address

School Guidance Counselor's Name

Counselor's Email Address

T-Shirt Size

Small

Medium

Large

X-Large

Parent / Guardian Information

Parent/Guardian Name(s)

Parent/Guardian Home Phone

Parent/Guardian Work Phone

Parent/Guardian Email Address

Parent/Guardian Home Address

City

State

Zip Code

Emergency Contact Information

Emergency Contact Name(s)

Relationship to Applicant

Emergency Contact's Work Phone

Emergency Contact's Home Phone

Emergency Contact's Mobile Phone

Criminal History

Live in Mecklenburg County

Yes

Have you ever been arrested?

Yes

Have you ever been suspended from school in the last 2 years?

Yes

Have you ever used illegal drugs?

Yes

Have you ever been issued a traffic citation?

Yes

Explanation of criminal history, if answered YES to any of the above questions.

Questions

1. What do you hope to gain by attending the High School Police Academy?

2. What type of community and/or volunteer activities do you participate in and how do you think that these activities impact our society?

3. Tell us something about yourself. How do you like to spend your free time? Hobbies?

4. Due to recent events in the media what is your opinion of the Law Enforcement?

5. What qualities and/or characteristics may distinguish you from other applicants?

Document Signers

- Applicant