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2. First Name
3. Middle Initial
4. Last Name
6. Home Address
8. City
9. State
10. Zip
12. Home Phone
13. Work Phone
14. Cell Phone
16. Email
17. Date of Birth
19. Drivers License Number
21. Emergency Contact Name
22. Phone
24. Relationship
26. Address
28. City
29. State
30. Zip
34. T-Shirt Size*
    -- Select One --SmallMediumLargeExtra Large
35. Waist Size*
    -- Select One --YXSYSYMYLYXL

    Students may use duty belts worn over their pants
36. Left or Right Handed*

    1. Left handed
    2. Right handed
38. Photography Release
    Photography Release Form

    Instructor's take student photos in action during the course. The Department may use certain photos in publications to promote the program. This form is intended to inform you and obtain your authorization.
40. Photography Release Form Return
    To upload completed Photography Release Forms
42. Why do you want to attend the Mount Vernon Police Department's Preparatory Academy?
46. REFERENCES
48. Please obtain two letters of recommendation (list names below). Include one from a school teacher or counselor, and one from a person associated with your extra-curricular activities (coach, religious leader, supervisor, etc). Please submit the letters of recommendation with your application.
50. Letter of Recommendation 1 may be uploaded here or returned to the Mount Vernon Police Department.
51. Letter of Recommendation 2 may be uploaded here or returned to the Mount Vernon Police Department.
53. First Name
54. Last Name
56. Address
58. City
59. State
60. Zip
62. Phone
64. First Name
65. Last Name
67. Address
69. City
70. State
71. Zip
73. Phone
77. PARENT/GUARDIAN INFORMATION
79. First Name
80. Last Name
82. Address
84. City
85. State
86. Zip
88. Phone
90. My parent/guardian has granted me permission to attend.

    1. Yes
    2. No
94. All applicants are subject to a background check.
96. I authorize the Mount Vernon Police Department to do a background check of my driving and criminal records.

    1. Yes
    2. No
Leave This Blank:


98. 1. Receive an email copy of this form.
99. Email address

    This field is not part of the form submission.

100. Submit

* indicates a required field