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Teen Police Academy Application

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First Name*
Middle Name*
Last Name*
Address*
Address Line 2
City*
State*
Zip Code*
Applicant Phone*
Applicant Email
Applicant's Date of Birth*
Applicant's Date of Birth
School and Grade for this upcoming fall (e.g. San Leandro High School, Sophomore)*
Parent / Emergency Contact Name*
Parent / Emergency Contact Email*
Parent / Emergency Contact Phone*
Please explain why you are interested in attending the San Leandro Police Teen Academy. Please include community groups you are actively involved with and extracurricular activities you participate in.*
Have you ever been arrested in any jurisdiction?*
1. Yes
2. No
If yes, please explain:

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Teen Police Academy Application

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