EXIT Citizens' Academy sign-up - Stoke South Question Title * 1. Name OK Question Title * 2. Date of birth Date / Time Date OK Question Title * 3. Home address OK Question Title * 4. Please confirm which area of Stoke-on-Trent you live in. Fenton and Mount Pleasant Hanford and Trentham Dresden, Florence and Normacot Blurton and Newstead Meir Park Meir and Weston Coyney Broadway and Longton East Meir Hay and Sandford Hill Bentilee and Ubberley Shelton Hartshill and Basford Penkhull and Stoke Springfield and Trent Vale Boothen and Oakhill OK Question Title * 5. Telephone number OK Question Title * 6. Those already involved with Staffordshire Police cannot apply. Are you: Employed by Staffordshire Police Volunteer for Staffordshire Police Special Constable for Staffordshire Police Partnership worker for Staffordshire Police None of the above OK Question Title * 7. Email address OK Question Title * 8. Job title OK Question Title * 9. Employer name and address OK Question Title * 10. Privacy statement I confirm I agree with the Staffordshire Police privacy statement and agree to receive communications via email about this programme. OK Question Title * 11. Residence I can confirm I am a resident within Stoke-on-Trent OK DONE