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2. First Name*
3. Last Name*
5. Address*
6. City*
7. State*
9. Phone Number*
10. Email Address*
11. Date of Birth*
    Date of Birth
13. Driver's License #*
14. DL / ID State*
15. How did you learn about the RPD CPA*
    -- Select One --FacebookInstagramTwitterRosenbergPolice.comNewspaperOther
17. Occupation*
18. Community Group Affiliation (if applicable)
20. Why do you wish to attend the Citizen Police Academy?*
22. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) you understand the rules and authorize the Rosenberg Police Department to conduct a background investigation, including a criminal history check, prior to being accepted into the Citizen Police Academy. 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
24. Electronic Signature*
Leave This Blank:


26. Submit

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