Law Enforcement Training Academy Application

Legal Name as it appears on your Social Security Card Legal Name as it appears on your Social Security Card First Last
Personal Email Address
EmailTrinidad State Email Address
Phone Phone - ### - ### ####
Trinidad State Student ID Number (Not Social Security Number)
Today's Date Today's Date / MM / DD YYYY
Date of Birth Date of Birth / MM / DD YYYY
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Colorado Resident?

Colorado Resident? Yes No If No, What State is Your Legal Residence?
Driver's License Number
State Driver's License Issued From State Driver's License Issued From / MM / DD YYYY
Emergency Contact Person
Emergency Contact Address Emergency Contact Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Emergency Contact Phone Emergency Contact Phone - ### - ### ####
High School Graduate or High School Equivalency?

High School Graduate or High School Equivalency? Yes No
High School Graduation Date High School Graduation Date / MM / DD YYYY
Are you a Veteran?

Are you a Veteran? Yes No
Military Branch
Certificate of Release - DD 214?

Certificate of Release - DD 214? Yes No
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.