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Citizens Academy Application


*What term are you applying for?
*Have you applied before?


Participant Information

*Name (first, middle, last)
*Address
Street # and name Apartment #
City State ZIP code
Mailing Address
(if different from home/business address)
Street # and name Apartment #
City State ZIP code
*Phone
Alternate phone
*Email


Eligibility & Attendance

Participants must be a resident of Gwinnett County, have a business in Gwinnett, or be an enrolled student in a Gwinnett college or university. Participants must attend all sessions and are required to attend the orientation and graduation.

*Please check all that apply

I am a resident of Gwinnett County
I have a business in Gwinnett County
Name of business
I am a student of a Gwinnett college or university
Name of school
Can you attend all classes? Check Schedule

If no, which dates?
How long have you lived or owned a business in Gwinnett?
Do you currently serve on a County Board or Commission?

If yes, please explain
Do you require any special accommodations to participate (including dietary restrictions)?

If yes, please explain
How did you hear about Citizens Academy?

Please limit to 1000 characters.
Why do you wish to participate in the Citizens Academy?

Please limit to 1000 characters.
What services or government functions are you primarily interested in learning more about?

Please limit to 1000 characters.
Please list any community involvement in the past 5 years?

Please limit to 1000 characters.
Education history

Please limit to 1000 characters.
Please list any leadership positions you've (currently/previously) held in Gwinnett County

Please limit to 1000 characters.
Have you participated in any other county citizen programs?

If yes, please explain


Emergency Contact Information

In case of emergency, who should we contact?

Name
Address
Street # and name Apartment #
City State ZIP code
Relationship to you
Phone
Alternate phone
Email


Additional Information

The following is for statistical purposes and to ensure that we reach a cross section of the Gwinnett community.

*Gender
*Race/Ethnicity
*Age
*Date of Birth (mm/dd/yyyy)
*T-shirt size
Other:


Signature & Submission Process

By submitting the form, you agree to the program requirements and attendance policy. Understand that your application submission does not guarantee you a slot in the program. Participants will be selected by an independent selection committee. You agree that the information stated in the application is true to the best of your knowledge

Verification:

Verification Code Enter the verification code :

Questions? Please contact Nicole Love Hendrickson at 770.822.8877 or nicole.hendrickson@gwinnettcounty.com.