Jefferson County Citizen Corps Council

Member Enrollment Page

* required  * required  * required  * required  * required  * required  * required Male Female  * required White Black Asian Arabic Indian Do you require special accommodations? Do you have any special training or skills?  * required I have been convicted of a crime NONE Traffic/DUI Misdemeanor Felony Please explain: Are you currently on Probation or Parole Please explain:  * required  * required  * required  * required  * required  * required  * required  * required I Agree to a Background Check