Professional Documents
Culture Documents
NAME First____________________________________________
Middle________________
Last ________________________________________________________________________
Date of Birth _______________________________________________________________________
Address ___________________________________________________________________________
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EMAIL _____________________________________________________________________________
Telephone ________________________________________Cell ____________________________
Employer __________________________________________________________________________
Your Job Description _______________________________________________________________
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In what community service groups are you active in? _______________________________
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What community activities have you been involved in? ______________________________
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What do you hope to achieve in the Citizens Academy? ____________________________
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Do you anticipate being able to attend ten Tuesdays in a row from 6:30 -9:30 pm
beginning March 10th, 2015? _____________________________
Shirt Size __________________________
Have you ever been arrested? ____________________________________________________
SIGNATURE__________________________________________________________