This information is for statistical purposes only. The information is voluntary and will not be used to determine accept
Lompoc Police Department
Self Defense Course Application Form Contact information will be used to contact applicants regarding course information and participation.
Applicant Information Full Name: First and Last
Address: Street Address
Apartment/Unit #
City
Home Phone:
(
State
ZIP Code
)
DOB:
Email:
Voluntary Information This information is for statistical purposes only. The information is voluntary and will not be used to determine acceptance of application. Information is confidential. Racial or Ethnic Group ☐
American Indian/Alaskan
☐
Asian/Pacific Islander
☐
Black/African American
☐
Hispanic/Latino
☐
White/Caucasian
☐
Other
☐
Male
Gender ☐
Female
How did you hear about this position? ☐
Newspaper
☐
Flier
☐
Other
☐
City Employee
. Please tell us why you are interested in participating in this course.
