REGISTRATION FOR THE WELLESLEY POLICE DEPARTMENT

CITIZEN POLICE ACADEMY

OCTOBER 3, 2018 – DECEMBER 12, 2018
6:30 P.M. TO 8:30 P.M.
If you are interested in attending, please complete the attached application form and mail it to:
Wellesley Police Department
Citizen Police Academy
485 Washington Street
Wellesley, MA 02482
or
Email the completed application to: mcleary@wellesleyma.gov or mwall@wellesleyma.gov.

Classes are limited to 25 students per session. Applicants will be notified of their acceptance a
week prior to the start date.
APPLICATION FORM
(Form may be copied for additional applicants.)
PLEASE PRINT
Name_________________________________________________________________

Address_______________________________________________________________

Apt.#_________________________________________________________________

Town_________________________________________________________________

Zip___________________________________________________________________

Phone________________________________________________________________

Date of Birth___________________________________________________________

Social Security No.______________________________________________________

Email Address: _________________________________________________________

I give the Wellesley Police Department authority to conduct a criminal history records check.

Signature____________________________________________________________________

Date________________________________________________________________________