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501 N. Maple #410I Blackfoot, Idaho I 83221I (208) 785-1235I www.cityofblackfoot.org Dear Applicant, Thank you for inquiring about the Blackfoot Police Department Citizen’s Academy. If you are interested in attending, please complete the information below and return it as soon as possible. There will be a limited number of available seats. Any falsification of the information on this form will be grounds for immediate dismissal. Full Name (First, Middle, Last): Idaho Driver’s License or Identification Number: Date of Birth (Month, Day, Year): Home Address: Street City State Zip Code Home Phone: Cell Phone: Email: Occupation: Work or School Address: Street City State Zip Code I ☐ live ☐ work or ☐ go to school in the city of Blackfoot I certify that all statements on this form are true and complete to the best of my knowledge. I consent to a record and warrant check to determine my eligibility to participate. If accepted, I will abide by all rules and regulations. In order to graduate, I understand I must complete all of the citizen’s academy classes. Signed: Date: Please return this completed application to Captain Wheatley at the Blackfoot Police Department, or you may email it to him at [EMAIL REDACTED] . For any questions regarding the citizens academy, contact Captain Wheatley can be reached at (208) 782-3085. Blackfoot Police Department Citizen’s Academy Application T-SHIRT SIZE XS☐ S ☐ M☐ L ☐ XL☐ XXL☐ OTHER