Pre-application

Full Name:

Address: (street)

City, Zipcode:

Age & Date of Birth:

Phone:

Alt phone:

Email:

Name of School: , Grade:

List any dealing with police, court, or school disciplinary action:

List three (3) adult references (name, phone, relationship):

Do you know any police officers or explorers? (list names and departments):

Answer the following if under 18 years of age.

Fathers Name and address:

Mother Name and address:

The program is for Lake County residents ages 14-21 years of age that have a genuine interest in law enforcement as a future profession. As part of the application process a background check will be performed. Applicants will be denied if any information is found to be false or purposely omitted. Click "Send"below to submit information.