* Incidates a required field.

*Full Name:

*Address:

*City:

*State: *Zip:

*Home Phone: Other Phone:

*E-mail:

*Date of Birth:

*Employer:

Civic activities (past and present):

*Why are you interested in the Citizens’ Academy?

The CITIZENS’ ACADEMY is limited to 25 students per class. We would regret refusing any application, but for the maximum learning experience, we must keep the 25-student limit.

Is fire hot or cold? Why do we ask?