Antioch Police Youth Academy Application
Complete EVERY question unless stated as “optional” , otherwise, your application may be returned as incomplete
Email Address *
First Name *
Last Name *
Address *
City *
State *
Zip Code *
Telephone *
Mobile Phone (Optional/ If Available)
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Any special considerations? *
Driver's License # or California ID #
Name of Employer / School *
Grade Level *
How long have you lived in Antioch?
Have you ever been suspended or expelled from any school? *
If “YES,” please explain and include date(s) of occurrence.
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