Lee County Sheriff’s Office
CITIZENS
ACADEMY

Sheriff Mike Scott
"Proud To Serve"
14750
Six Mile Cypress Pkwy.
Fort Myers, FL 33912
EMERGENCY 9-1-1
Non-Emergency 477-1000
Web Site: www.sheriffleefl.org
PURPOSE
ELIGIBILITY STANDARDS
There is NO CHARGE to any participant who attends the Academy
WHAT IS IT?
BENEFITS
When residents take a more personal interest in their community and neighborhoods, they will enjoy a safer and closer relationship with their neighbors. It is our hope that the graduates will become partners with us in identifying problems and solutions to crime issues that are affect our community and take their knowledge back into their neighborhoods where they can use it to enhance the quality of life.
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CURRICULUM HIGHLIGHTS |
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| Date | / / | Maiden | Name you prefer to go by |
| Legal Name: | Last | First | Middle |
| Circle One: Mr./ Mrs./ Miss | Race | Gender: | Male | Female |
| Home Address | City | State | Zip |
| Date of Birth | / / | Social Security Number | / / |
| Home Phone | ( ) - | Business Phone | ( ) - |
| E-Mail address | Cell/Pager | ( ) - |
| Place of Employment |
| Title/Position |
| Emergency Contact | Phone | ( ) - |
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Business Address |
City | State | Zip | ||||
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I prefer to be contacted at (check one or both) Home __ Work __ |
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| Have you ever been arrested? Yes __ No __ If yes, list the jurisdiction where arrested and the charge: | |||||||
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Have you ever used an alias? Yes __ No
__ Please list all aliases below. |
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I was referred by |
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| All applicants are subject to a criminal background check. I certify that all statements are true and correct to the best of my knowledge and that my application may be rejected for any reason. | |
| Signature of Applicant |
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Please print, complete, sign, and mail or fax to: |
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| Citizen's Academy Coordinator | ||
| Lee County Sheriff's Office | Phone | 239-477-1127 |
| 14750 Six Mile Cypress Parkway | FAX | 239-477-1182 |
| Fort Myers, FL 33912 |