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7. Kings Mountain Public Safety Citizens Academy Application

    

9. The Kings Mountain Public Safety Citizens Academy is a series of interactive classes designed to teach participants about the City's Police and Fire Services and to develop future leaders through well informed and engaged citizens. To be considered for the 2025 Spring Session, fill in the below information and submit before February 28th, 2025. All applications will be vetted and if accepted for participation in this class you will be contacted with further information. 

   
   

   For more information on the Academy, call 704-734-0444 or email one of our Community Resource Officers @ 

   robert.medlin@cityofkm.com

   
   

      

11. Full Name
12. Email Address
14. Driver's License #
15. DOB
17. Mailing Address
19. City
20. State
21. Zip Code
23. Phone Number
24. Mobile Number
26. Employer Name & Address
28. Briefly discuss what you hope to learn as a particpant in the Public Safety Citizens Academy and how you plan to use the information.
30. How did you hear about the Citizens Academy?
32. The Citizens Academy will be held on Tuesday evenings from 6:00 pm - 8:00 pm starting March 18th, 2025 and concluding May 13th, 2025. There will also be a graduation ceremony on May 27th, 2025 were participants will be recognized for their participation at the regularly scheduled city council meeting. Will you be able to attend these dates and time?

    1. Yes
    2. No
34. Emergency Contact Information
36. Name
37. Email Address
39. Address
41. City
42. State
43. Zip Code
45. Phone Number
46. Mobile Number
48. Optional: To ensure that we reach a cross section of our community and for statistical purposes, please describe your:
50. Gender:
51. Race or Ethnicity:
53. Age:

    1. 18-30
    2. 31-50

    1. 51-70
    2. 71 or over
55. Do you have any special accommodations or have special dietary needs?

    1. Yes
    2. No
57. If yes, please identify
Leave This Blank:


59. 1. Receive an email copy of this form.
60. Email address

    This field is not part of the form submission.

61. Submit Submit and Print

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