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Citizens’ Academy
Lance Feyh, Crime Prevention Sergeant
320 S Kansas - Map
Topeka, KS 66603
785-368-9497 Tel
Fill out and submit this form - or download a printable version here.
Personal Data
If you have ever used any other surnames, or legally changed your name, please state
the time period this occurred and the circumstances. If you have ever legally changed
your name, please list date, place, and court:
Address and Point of Contact
Please list (below) the name and phone number of a relative or close associate (to be used in the event of an emergency):
Employment Information
Authorization to Conduct Law Enforcement Checks
If yes, list details (below) pertaining to conviction, including date, place, law enforcement agency, charge, court and disposition
I hereby authorize the Topeka Police Department to conduct a criminal history check of law enforcement records as they pertain to me, I understand that this check will include, but not be limited to, any record of charges, prosecutions, or convictions for criminal or civil offenses. This check will be used for the purpose of the Topeka Police Citizens Academy application process. My consent is valid for six months from the date authorized below. Any information obtained will be used for the purpose of providing clearance to participate in the Topeka Citizens’ Academy.
Notice: Applicants must live, work, or have an interest in the City limits of Topeka, KS and must be at least 18 years of age. A criminal back ground check will be made on applicants before they are accepted to the academy. Applicants can not have a felony conviction and cannot have a DUI or drug conviction in the last seven (7) years.
Organization Memberships
Please list (below) any organizations or community groups to which you belong
How did you hear about Citizen’s Academy?
Medical
If yes, provide details (below)
For more information call Crime Prevention Unit (785) 368-9497 or email Sgt. Lance Feyh at lfeyh@topeka.org
Last Updated: Thursday January 03 2008

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