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2024-04-05T09:51:13-05:00
Law Enforcement Academy Application Form
PLEASE READ BEFORE SUBMITTING YOUR APPLICATION:
ACADEMY DOCUMENTS
Are you planning to attend the Full-Time Academy for the session beginning in January 2025?
Yes
GENERAL INFORMATION
Name
(Required)
First
Middle
Last
Previous Names Used
If including your maiden name, please include a copy of your Marriage Certificate if your last name is different. If you have had other name changes, please include a copy of your Judgment and Order to Change Name.
Name Change Documentation
Max. file size: 20 MB.
Please upload your Marriage Certificate or Judgement and Order to Change Name here.
Date of Birth
(Required)
Month
Day
Year
Email Address
(Required)
Phone
(Required)
Mailing Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Have you previously applied for admittance into any other basic law enforcement academy?
(Required)
Yes
No
If yes, please indicate the name of the training center AND the state in which it was located:
If you did not attend this training center, or your application to attend was not accepted, please list why:
EMERGENCY CONTACT INFORMATION
Name
(Required)
First
Last
Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Relationship
(Required)
Phone
(Required)
AGENCY INFORMATION
Agency Name:
Agency Sponsorship
Yes
No
Supervisor Name
First
Last
Supervisor Email Address
Supervisor Phone Number
EDUCATION
High School Name
High School Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Did you graduate?
(Required)
Yes
No
Date
(Required)
Month
Day
Year
Do you have your G.E.D.?
(Required)
Yes
No
Year you obtained your G.E.D.
(Required)
City and State you obtained your G.E.D. in
(Required)
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
MILITARY / DRIVING / ARREST RECORDS
Are you a veteran of military service?
Yes
No
If yes, please provide a copy of your DD-214.
File
(Required)
Max. file size: 20 MB.
Please upload your DD-214 here.
Date of Discharge
(Required)
Month
Day
Year
Type of Discharge
(Required)
Have you ever been arrested and/or convicted of a felony, including the receiving of a Suspended Imposition of Sentence, following a plea of guilty to a felony charge?
(Required)
Yes
No
Have you ever been arrested and/or convicted of a misdemeanor to include a DWI, BAC, Leaving the Scene?
(Required)
Yes
No
Have you ever been involved in, arrested and/or convicted of a misdemeanor or felony in this or any other state?
(Required)
Yes
No
FINANCIAL AID
Student Type
Degree Seeking (This means you MAY be eligible for Federal Financial Aid)
Non-Degree Seeking (This means you will NOT be eligible for Federal Financial Aid)
Please choose your Financial Aid situation
Agency Sponsorship
VA/GI Bill Benefits
Pell Grants
Scholarships
Workforce Development
Direct Pay (No assistance)
Other (Please describe)
Please describe your Financial Aid situation
You are seeing this field because you have chosen "Other".
By checking this box, I am confirming that I downloaded and read the informational PDF linked at the beginning of this application.
(Required)
Yes, I have read the informational PDF at the beginning of this application.
By checking this box, I certify that the information given herein is true and accurate to the best of my knowledge. I understand that any omission or falsification of the above information will disqualify me from attending the Missouri Western State University Law Enforcement Academy.
(Required)
I understand the terms, and the information I have given is true and accurate to the best of my knowledge.
Consent to Inquiry & Release of Information
(Required)
I understand that the Missouri Western State University Law Enforcement Academy will conduct, or cause to be conducted, a law enforcement records inquiry to learn of any criminal record data pertaining to myself.
I hereby authorize this inquiry, and the release of such information to the Missouri Western State University Law Enforcement Academy.
Comments
This field is for validation purposes and should be left unchanged.
