2. Instructions

   Please complete and submit the form below. An officer from the Coralville Police Department will contact you after we have received and reviewed your application.

   Note: Information submitted on this form will be sent to the Coralville Police Department via email. To protect sensitive information, do not provide the following information on this form: Social Security or driver’s license numbers, bank account information, medical information, passport numbers, and passwords.

   Applications must be received by 5:00 pm on January 9, 2023 to be considered for the 2023 Academy.

3. 
7. Resident Information
9. First Name*
10. Middle Name*
11. Last Name*
13. Address*
15. City*
16. State*
17. Zip Code*
19. Cell/Home Phone*
20. Work Phone
21. Date of Birth*
23. Email address
27. Employer Information
29. Employer*
30. Occupation
32. Employer's Address
33. Employer's City, State, & Zip Code
37. Additional Information
39. Have you been arrested for any offense other than a traffic violation?*

    1. Yes
    2. No
41. If yes, what for?
42. When?
43. Where?
47. Attendance

    A $10 participation fee is required to cover the costs of material and shirts. Please bring payment the first week of class. Make checks payable to the Community Police Academy.

49. Are you able to attend six or more sessions?*

    1. Yes
    2. No
50. What size shirt do you wear?*

    1. S
    2. M
    3. L

    1. XL
    2. XXL
    3. XXXL
52. Why do you want to attend the Community Police Academy?*
56. Please Review*

    I hereby certify that the information in this application is true and complete to the best of my knowledge. You are authorized to make any investigation of my personal history deemed necessary of consideration to attend the Community Police Academy.

    1. I understand and agree to the above.
58. Name of person submitting form*
59. Date*
    Date
63. Participant Instructions
    1. The Community Police Academy shall not interfere with routine operations of any law enforcement agency.
    2. During ride along activities, participants will follow all instructions given by the officer.  No interference with the performance of any officer shall be permitted.
    3. The student shall not be armed at any time.
    4. Participants who are asked to identify themselves should explain that they are a Community Police Academy participant.
    5. SMOKING IS NOT ALLOWED in any government building or vehicle.
    6. A criminal records check will be conducted on all applicants prior to acceptance into the Academy.
    7. All participants will conduct themselves in an appropriate and professional manner.
    8. Violation of any instruction, guideline, rule or failure to comply with a reasonable request will terminate the citizen’s participation in the Academy.  This is at the discretion of any member of the Coralville, Iowa City, North Liberty, or University Police Departments, or Johnson County Sheriff’s Office.
    9. The maximum number of times a participant can attend the Community Police Academy is two.
    10. The maximum number of times a participant can miss class is 3 times, total during the academy.
    11. All applicants must be at least 16 years of age by January 23rd, 2023.

    In consideration of the above law enforcement agencies granting permission to enter in or upon any premises or vehicles which are under their actual care or constructive or passive control, I hereby waive all claims to damage or loss to my person or property which may be caused by any act, or failure to act, of the Coralville, Iowa City, North Liberty and/or University Police Departments, and/or Johnson County Sheriff’s Office officers, agents or employees. I assume the risk of all dangerous conditions in, upon or about the premises or vehicles and waive any and all notice or existence of such conditions.

65. Agreement*

    1. I certify that I understand the requirements and responsibilities of participants in this program.
67. Applicant Name*
68. Date*
    Date
70. After you submit this form, you will be automatically taken back to www.coralville.org/CommunityPoliceAcademy

    You should receive an email copy of your submitted form at the email you provide below.  If you do not receive an email, check your spam folder for noreply@civicplus.com.

Leave This Blank:


72. 1. Receive an email copy of this form.
73. Email address

    This field is not part of the form submission.

74. Submit

* indicates a required field