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IMPORTANT NOTICE: PLEASE DO NOT BEGIN FILLING OUT THE APPLICATION UNTIL YOU ARE PREPARED TO ANSWER THE 2 ESSAY QUESTIONS. EACH ESSAY QUESTION REQUIRES A RESPONSE OF AT LEAST 250 WORDS. 

**INCOMPLETE APPLICATION SUBMISSIONS WILL NOT BE CONSIDERED FOR ENROLLMENT.**

Thank you for your interest in the 2017 Morris County Public Safety Youth Academy. The following information is REQUIRED of all prospective participants seeking candidacy for the Morris County Public Safety Youth Academy program. Any applications that are submitted with false or incomplete information will not be considered for enrollment in this program. Please note that this application contains 40 questions, and may take up to 1 hour to complete.

The application requires you to submit information regarding your current medication(s), alternate emergency contacts, and your high school's contact information. If this information is not easily accessible to you before beginning the application, please collect this information before you start filling out the application.

In addition, we ask that all candidates complete this application with a parent/guardian.

**TO ENSURE THAT YOUR APPLICATION WILL BE CONSIDERED FOR ELIGIBILITY, PLEASE MAKE SURE THAT YOU HAVE CAREFULLY READ ALL OF THE DIRECTIONS LISTED ABOVE, AND THAT YOU ARE PREPARED TO COMPLETE THE APPLICATION IN ITS ENTIRETY BEFORE YOU BEGIN.**

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* 1. Cadet Last Name

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* 2. Cadet First Name

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* 3. Street Address

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* 4. City

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* 5. Zip Code

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* 6. Home Phone #
    (000-000-0000)

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* 7. Cadet Cell #
    (000-000-0000)

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* 8. Cadet Email Address

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* 9. Date of Birth (MM/DD/YYYY)

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* 10. Gender

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* 11. Age

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* 12. Parent/Guardian First Name

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* 13. Parent/Guardian Last Name

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* 14. Parent/Guardian Email

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* 15. Parent/Guardian Primary Contact #
      (000-000-0000)

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* 16. Parent/Guardian Secondary Contact # 
      (000-000-0000)

For Questions #17-19, please provide the appropriate information for an alternate emergency contact other than the parent/guardian listed above.

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* 17. Alternate Emergency Contact's Name (First and Last)

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* 18. Alternate Emergency Contact's Relationship to Cadet

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* 19. Alternate Emergency Contact's Primary Phone #
      (000-000-0000)

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* 20. Name of High School

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* 21. City of High School

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* 22. Phone # of High School 
      (000-000-0000)

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* 23. Have you ever been suspended or expelled from school?

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* 24. If "Yes", please explain when and why you were suspended or expelled from school.

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* 25. Upcoming grade (Grade for the 2017-2018 school year)

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* 26. Please indicate if you have received any of the certifications listed below. (Please note: possession of any of the following certifications will in no way help, or hurt, the admission decision)

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* 27. If you have indicated in Question #26 that you are Heartsaver CPR or Professional Rescuer CPR certified, please provide the expiration date of your certification.

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* 28. Have you participated in the MCPSYA program in the past?

PLEASE COMPLETE QUESTIONS #29-36 WITH A PARENT/GUARDIAN.

Please list below any prescribed medications that your child is required to take regularly. Please indicate whether or not your child will be required to take or carry the medication with him/her during the Morris County Public Safety Youth Academy (8:30am - 4:30pm). All medication(s) must be in the original prescribed package. A certified EMT will be available during the academy for any medical emergencies.

Please be advised that the cadets may be afforded the opportunity to participate in physical activities such as defensive tactics, simulated firearms training, firefighting, and/or other outdoor exercises. Should you wish that your child does NOT participate in a certain activity, or should your child have any special restrictions, please provide this information below.

**INFORMATION PROVIDED IN THIS SECTION WILL BE HELD IN STRICT CONFIDENCE IN ACCORDANCE WITH THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT.**

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* 29. My child:

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* 30. If you have indicated in Question #29 that your child DOES take prescribed medications, please provide the following information:

- Name of Medication(s)
- Medical Condition(s) for which medication is needed
- Doseage 
- Administration

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* 31. Does your child have any disabilities/access/functional needs/restrictions you would like to disclose at this time?

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* 32. If "Yes," please describe:

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* 33. Does your child have any medical or cultural dietary restrictions?

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* 34. If "Yes", please specify dietary restrictions:

I CERTIFY THAT THE ABOVE INFORMATION REGARDING MY CHILD'S USE/NON-USE OF PRESCRIPTION MEDICATIONS AND DIETARY RESTRICTIONS IS COMPLETE AND ACCURATE.

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* 35. Parent/Guardian Electronic Signature (First and Last Name)

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* 36. Date (MM/DD/YYYY)

For Question #37-38 please indicate your TRUE clothing size. Oversized or undersized clothing will not be acceptable as part of the MCPSYA uniform, and the cadet will be required to select uniforms in the closest size available.

Please note: Sizing is based on men's clothing sizes

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* 37. T-Shirt Size

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* 38. Gym Short Size

THANK YOU FOR ANSWERING THE APPLICATION QUESTIONS. IN ORDER TO COMPLETE YOUR APPLICATION, YOU ARE REQUIRED TO ANSWER THE FOLLOWING ESSAY QUESTIONS.

EACH ESSAY RESPONSE MUST BE AT LEAST 250 WORDS. YOUR RESPONSE TO EACH  QUESTION MUST MEET THIS REQUIREMENT IN ORDER FOR YOUR APPLICATION TO BE CONSIDERED. AS A REMINDER, EACH YEAR WE RECEIVE AN INCREASING NUMBER OF APPLICATIONS, AND A THOUGHTFUL, WELL WRITTEN ESSAY RESPONSE, MAY SEPARATE YOUR APPLICATION FROM THE OTHERS.  


ESSAY QUESTION #1:
Why do you want to attend the Morris County Public Safety Youth Academy?


ESSAY QUESTION #2:
What makes you a good candidate for the Morris County Public Safety Youth Academy?

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* 39. Response to Essay Question #1:

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* 40. Response to Essay Question #2:

By entering the information required below, you certify that this application is complete and accurate to the best of your ability and knowledge.

You understand that the intentional falsification of any information on this application will result in the immediate dismissal of your application submission for the 2017 Morris County Public Safety Youth Academy.

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* 41. Parent/Guardian Electronic Signature

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* 42. Cadet Electronic Signature

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* 43. Date (MM/DD/YYYY)

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