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2. First Name
3. Middle Initial
4. Last Name
6. Home Address
8. City
9. State
10. Zip
12. Home Phone
13. Work Phone
14. Cell Phone
16. Email
18. Your Occupation
19. Employer
21. Business Address
23. City
24. State
25. Zip
27. Date of Birth
28. Drivers License Number
30. All applicants are subject to a background check
34. What are your community interests?
36. Why do you want to attend the Citizens Academy?
38. How did you hear about Citizens Academy?
40. Have you ever been arrested for a crime? (Including charges that were later dismissed) Please explain briefly:
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42. 1. Receive an email copy of this form.
43. Email address

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44. Submit

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