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Teen Police Academy Application
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First Name
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Middle Name
*
Last Name
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Address
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Address Line 2
City
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State
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Zip Code
*
Applicant Phone
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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?
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