City of Burlington - Community Police Advisory Team Application- ROUND 2
The following application is used by the Burlington City Council to appoint members of the Community Police Advisory Team. The City of Burlington is seeking additional applicants to fill seats of the Community Police Academy. Please apply if you are an Educators, youth (18 and under) or a Justice Practitioner.  
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Email *
Name (First,Middle,Last)
Date of Birth
Street Address
City, State, Zip Code
Phone Number
Race/Ethnicity
Gender
Email Address
Have you been on a ride-along with the Burlington Police Department?
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Have you attended the Burlington Community Police Academy?
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Have you attended a Racial Equity Learning Opportunity?
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The CPAT charter is designed to ensure that representation mirrors the community the Burlington Police Department serves. As applications are considered by the Burlington City Council, representation of the communities listed below will be taken into consideration. Please check all of the boxes of communities/organizations/groups you are representative of, an employee of, and/or member of. Please check all that apply.
Are you a member of a Faith-based community? If so, which community?
Why do you wish to serve the City of Burlington in this capacity? Describe the experience, skills, and abilities that you would contribute.
I acknowledge that if I am chosen to serve on the City of Burlington Community Police Advisory Team as a representative of one of the above communities, I agree that: 1. I am eligible based upon the published criteria. 2. I will be able to attend monthly meetings. 3. I will participate in the Community Police Academy within one year of appointment (if I have not already done so). 4. I will do at least two ride-alongs per year. Please Write your full name and date.
Please List the names of all schools attended from high school through secondary education. Also list the highest degree achieved at each institution.
Please explain how your educational background will help you serve in this position. You may also elaborate on how your skills or certifications obtained outside of your formal education will enhance your contribution to the advisory team while you serve.
Employer/Company:
Employer's Address
Length of Employment
Job Title
Description of Job Responsibilities
Civic Involvement: Please list the names of the civic and volunteer organizations in which you currently hold membership and your position with that organization.
Thank you for your interest in the City of Burlington's Community Police Advisory Team.
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