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2. Please check the City of Longview Privacy Policy and Disclaimer before completing this form.
4. Personal Information
   minimum age for enrollment is 18 years
6. Name*
7. Identification Number
   Please be prepared to supply a U.S. government I.D. number such as Driver License or State Issued I.D.
9. Address*
11. City
12. State
13. Zip Code
15. Date of Birth*
    month, date, year
16. Phone Number*
    area code and phone number
17. Email Address
19. Business Name
21. Business Address
23. Emergency Contact
25. Name
26. Address
28. Phone Number
    area code and phone number
29. Relationship
31. Other Information
33. Are you a resident of Longview?

    1. Yes
    2. No
34. If yes, how long?
35. How did you hear about BPA?

    1. Newspaper
    2. Social Media
    3. Television
    4. Radio
    5. Former CPA Graduate
    6. Police Officer
    7. Other
36. If Other, please specify
38. Criminal History
    Longview Police Department will conduct a criminal history check on each applicant.
40. Have you ever been arrested?*

    1. No
    2. Yes
41. If "No", please submit N/A in the field below. If "Yes", please provide details of arrest including date, place of arrest, case disposition. *
45. Terms of the Program
    I hereby certify that there are no willful misrepresentations, omissions, or falsifications in the foregoing statements and answers to questions. I understand that any omission or false statements on this application shall be sufficient cause for rejection for enrollment or dismissal from the Longview Police Departments Citizen Police Academy. I further understand that the Longview Police Department Academy will be conducting a criminal history check. I declare that I have never been convicted of a felony offense in this state, or any other state, of the United States. I also understand that any student may be removed from the Longview Citizens Police Academy if said student is disruptive or otherwise inhibits the concept of this program.
47. Statement of Agreement*
    By typing your name in the above box, you agree to the "Terms of the Program" above.
48. Date
50. For additional information check the website at LongviewTexas.gov/BPA, call 903-237-1108
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52. 1. Receive an email copy of this form.
53. Email address

    This field is not part of the form submission.

54. Submit Submit and Print

* indicates a required field