Citizen Police Academy Application

The 2015 class is full. You can still submit your application to receive information about the next class.!!! If you would like to be considered for the next Citizen Police Academy, please complete and submit this form. As a reminder, you must live and/or work in Collierville to be eligible. If you need assistance with any portion of this form, contact Lt. David Townsend at (901) 457-2560 or by email at dtownsend@ci.collierville.tn.us. If you are under the age of 18, a parent or legal guardian must submit this form.

Full Name (First, Middle, Last) (*)

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Home Address (*)

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Home City (*)

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Work Address (if you do not live in Collierville) (*)

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Work City (*)

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Your profession (*)

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Phone (*)

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Email (*)

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Date of Birth (Select from calendar below) (*)


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Drivers Licene or ID number (If other than Tennessee, include state abbreviation) (*)

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Have you ever been convicted of a crime? (*)

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If yes, please explain circumstances.

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Have you been arrested within the past five years? (*)

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If yes, please explain circumstances.

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Do you have any physical limitation that would keep you from participating in this training? (*)

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Is there other information to consider regarding your application?

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By submitting this form, I authorize the Collierville Police Department to perform a background check on me (or the applicant if under age 18). I understand this background check can include searching local, state, and national databases for records that may prohibit my acceptance into the Collierville Police Citizen Police Academy class.

I have read and understood the information above. (*)

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Type what you see (*)
Type what you see

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