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Citizen Police Academy Application

Please complete the following form to apply for the next Citizen Police Academy which starts on (March 16, 2016). This is a 10 week program, and meets every Wednesday night from 6pm to 9pm. There is no cost to attend, and you must be 18 years of age to apply.

  • You must be at least 18 years of age
  • You should live or work in the City of San Rafael
  • You must not be convicted of a felony, or prohibited from owning or possessing a firearm
  • Applications must be received by February 29, 2016

  • ** This application is for the next class, which begins March 16, 2016. **

    Applicant Information:

    First Name:
    Middle Name:
    Last Name:
    Date of Birth: (You must be at least 18 years of age)
    Zip Code:
    Home Phone:
    Office Phone:
    Other Phone:
    Email Address:

    Drivers License Number:
    Drivers License State:
    Drivers License Class:
    Drivers License Expiration Date:
    Is your Drivers License Currently Valid? YES NO

    Have you ever been convicted of any felony? YES NO
    If yes, please explain where, when, and disposition:

    Place of Employment:
    Employer Address:
    Duties Performed:

    How do you feel the citizens' police academy will benefit you?

    What is your opinion of the San Rafael Police Department?

    I hereby certify that the answers are true and correct. By pressing "Submit", I authorize any of the academy law enforcement agencies to do a criminal history and background check for the purposes of this academy.

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