Citizen Police Academy Application

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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