VBEMS Citizen’s Academy Application

A Criminal Record Information Request and EMS Observer Application will be filed on the first night of the Citizen’s Academy.

Phone Number

Date of Birth

Name as you want it to appear on your name tag.

Shirt Size

There will be field trips involving standing and walking. Will you need any physical accommodations?

Yes

If you answered ‘yes’ in the previous question, please explain.

How did you hear about the VBEMS Citizen’s Academy and why are you interested in participating?

If you answered ‘other’ in the previous question, please explain.

Why are you interested in participating in the VBEMS Citizen’s Academy? What are you hoping to gain from this program?