Become an

Honorary Captain

with the South Salt Lake City Police Department

For Junior High and High School Students

Be part of a youth program to create activities and build positive relationships between youth and the police department.

For questions reach out to your school principal or send an email to: southsaltlakehonorarycolonels@gmail.com

Feel free to reach out to us if you have a question about how you can get involved. We look forward to hearing from you.

Name (First, Middle, Last)*

School Name

Grade

Home Street Address

City

State

Zip Code

Phone

Email Address*

Birthday

Shirt Size

Have you ever been convicted of a crime?

Yes

Consideration for Honorary Captain will be based on the following:
Applicant must be recommended by a teacher, principal, or active Honorary Colonel or Captain

Recommending Person Name and Relationship

Recommending Name

Relationship

Agreement and Signature

By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as an Honorary Captain, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.

Name (Initials)