Applicant Information Child's Name (First): * Child's Name (Last): * Age as of July 1, 2024: * Contact Information Name of Parent or Guardian (First): * Name of Parent or Guardian (Last): * Home Phone: * Daytime Phone: * Email Address: * Confirm Email Address: * Community Selection Please select the week you wish to attend: (Please select one option only.) * Week 1: Bedford, Lexington, Medford, Woburn (Week of July 8-12) Week 2: Arlington, Billerica, Burlington, Tyngsborough (Week of July 15-19) Week 3: Acton/Maynard, Framingham/Natick, Malden, Marlborough (Week of July 22-26) Week 4: Belmont/Watertown, Hudson, Wakefield, Waltham/Newton (Week of July 29 - August 2) Week 5: Chelmsford, Lowell, Tewksbury, Wilmington (Week of August 5-9) Please choose your Week 1 community bus stop: (If your community bus stop has reached the safety capacity, you may select the community's waitlist.) * Bedford Lexington Waitlist - Bedford Waitlist - Lexington Please choose your Week 2 community bus stop: (If your community bus stop has reached the safety capacity, you may select the community's waitlist.) * Arlington Tyngsborough Waitlist - Arlington Waitlist - Burlington Waitlist - Tyngsborough Please choose your Week 3 community bus stop: (If your community bus stop has reached the safety capacity, you may select the community's waitlist.) * Acton/Maynard Framingham/Natick Marlborough Waitlist - Acton/Maynard Waitlist - Framingham/Natick Waitlist - Marlborough Please choose your Week 4 community bus stop: (If your community bus stop has reached the safety capacity, you may select the community's waitlist.) * Belmont/Watertown Hudson Wakefield Waltham/Newton Waitlist - Belmont/Watertown Waitlist - Hudson Waitlist - Wakefield Waitlist - Waltham/Newton Please choose your Week 5 community bus stop: (If your community bus stop has reached the safety capacity, you may select the community's waitlist.) * Waitlist - Tewksbury Additional Information Will you have a need for consideration for one of the limited number of scholarships? * Yes No Child's Gender: (This information is optional and used only for applications to grant programs that help offset the cost of YPSA. The options listed reflect the options listed in these grant applications.) Select OneMaleFemaleNon-BinaryOtherPrefer Not to Answer Child's Race: (This information is optional and used only for applications to grant programs that help offset the cost of YPSA. The options listed reflect the options listed in these grant applications.) Select OneAmerican Indian/Alaskan NativeAsian/Pacific IslanderAsianBlackHispanicWhiteOther Comments: Once your application has been submitted, you will be contacted by a member of the YPSA staff via email regarding the status of your child's application. The fee for the YPSA is $100.00 per child. Upon acceptance to the YPSA, the staff will follow up with parents/guardians regarding payment and supplemental forms.Participants must be 8-12 years old. Breakfast, lunch, and snacks are provided. A graduation ceremony is held on each Friday; at least one parent or guardian is required to attend the ceremony. The cadets will be picked up each morning at 8:00am in their community at a designated location and will be dropped off at the pick up site at approximately 2:45pm each day (the exception being Friday when parents attend the graduation ceremony and cadets accompany them home). A staff member will be at the pick up site to ensure each cadet is picked up by a parent or guardian.Due to the close proximity of the YPSA to Chelmsford and Billerica, there will not be a bus stop for these two communities. Parents/Guardians will drop-off and pick-up the Cadets at the YPSA (40 Brick Kiln Rd., Chelmsford).All information on this application is confidential.Thank you for applying to the Middlesex Sheriff's Office Youth Public Safety Academy. Reminder, this is only an application and does not indicate the acceptance of your child. The staff of the YPSA will follow up with you regarding the status of your application. Please Check: * I have read and understand the requirements in the above statement: Leave this field blank
