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2. 
4. Full Name (First, Middle, Last)*
5. Driver's License Number*
7. Preferred Contact Number*
8. Email*
10. Home Address (City, State, Zip)*
12. Occupation (Full/Part Time)*
13. Employer (Name of Church)*
15. Church Address (City, State, Zip)
17. Shirt Size*

    1. Small
    2. Medium
    3. Large
    4. X-Large
    5. XX-Large
19. Please list any dietary restrictions (If this doesn't apply to you, write N/A)
21. Have you ever been convicted of a crime other than a minor traffic offense?*

    1. Yes
    2. No
22. Please explain*
24. I attest that the above statements made on this application are true and complete. I authorize the Battle Creek Police Department to examine this information to evaluate my participation in the Cops & Clergy Academy, as well as run a driving and criminal history check to ensure that there are no disqualifiers to prohibit my participation in the Cops & Clergy Academy. I understand that the Battle Creek Police Department Cops & Clergy Academy does not certify or qualify citizens to perform any law enforcement services.*
    Please sign your name above.
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26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

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