HomeMy WebLinkAboutBTB Application 2022-fillableBehind the Badge
A Community Police Academy Sponsored Event
2022 Application
Hosted by the Iowa City Police Department,
Johnson County Sheriff’s Office, North Liberty Police Department and the
University of Iowa Police Department
Please type or print legibly in blue or black ink.
Name:
Address:
First Middle Last
Street
Phone:
City State Zip Code
Cell/Home Work
Date of Birth:
Email:
Driver’s License Number & State:
Employer: Occupation:
Employer’s Address:
Street
City State Zip Code
Have you been arrested for any offense other than a traffic violation? Yes No
If yes, what for? When? Where?
Would you like to be considered for a scholarship? Yes No
Please list any accommodations you need:
Why do you want to attend the Behind the Badge Series?
I hereby certify that the information in this application is true and complete to the best of my knowledge. You are
authorized to make any investigation of my personal history deemed necessary of consideration to attend the
Behind the Badge series.
Applicant signature Date
Behind the Badge
2022 Series Participant Instructions
Hosted by the Iowa City Police Department,
Johnson County Sheriff’s Office, North Liberty Police Department and the
University of Iowa Police Department
1.The Behind the Badge shall not interfere with routine operations of any law enforcement
agency.
2.The student shall not be armed at any time.
3.Participants who are asked to identify themselves should explain that they are a Behind the
Badge participant.
4.Smoking is not allowed in any government building or vehicle.
5.A criminal records check will be conducted on all applicants prior to acceptance into the
Academy.
6.All participants will conduct themselves in an appropriate and professional manner.7.Violation of any instruction, guideline, rule, or failure to comply with a reasonable request will
terminate the individual’s participation in series. This is at the discretion of any member of the
Iowa City, North Liberty, or University Police Departments, or Johnson County Sheriff’s Office.
8.All applicants must be at least 16 years of age by March 23rd, 2022.
9.Participants must adhere to the University of Iowa and Johnson County mask policies.
10.A $10 participation fee is required to cover the costs of materials and supplies. Please attach
payment to this application. Checks are welcomed. Make checks payable to the City of Iowa
City.
In consideration of the above law enforcement agencies granting permission to enter in or upon any premises or
vehicles which are under their actual care or constructive or passive control, I hereby waive all claims to damage or
loss to my person or property which may be caused by any act, or failure to act, of the Iowa City, North Liberty
and/or University Police Departments, and/or Johnson County Sheriff’s Office officers, agents or employees. I
assume the risk of all dangerous conditions in, upon or about the premises or vehicles and waive any and all
notice or existence of such conditions.
I certify that I understand the requirements and responsibilities of participants in this program.
Applicant signature Date
Please mail or hand-deliver completed applications to either of the following locations:
Iowa City Police Department: 410 East Washington Street, Iowa City, IA 52240
North Liberty Police Department: 340 North Main Street, North Liberty, IA 52317
University of Iowa Police Department: 200 South Capitol Street, Suite 808, Iowa City, IA 52242
Applications must be received by 5pm on March 11th, 2022 to be considered for the 2022 series.
Behind the Badge
2022 Series Participant Instructions
Johnson County Community Police Academy sponsored event
Behind the Badge
Media Waiver
I, ____________________________________ (participant name) have been accepted to
attend the 2022 Behind the Badge series. To promote future participation in the Behind the
Badge series, local media may be on site taking photos, videos, and interviewing
participants throughout the length of the series.
Please check the appropriate box below and sign/date.
YES, I agree to the use of my photo/video/interview for current or future use
(circle all that apply)
NO, I do not want to be photographed, videoed, or interviewed
(circle all that apply)
_________________________________________________________________________________
Signature Date
PLEASE RETURN SIGNED FORMS WITH YOUR APPLICATION.