Gwinnett 101 Application

Citizens Academy Community Outreach Program Application Form

Citizens Academy Application

Fields marked are required.

What term are you applying for?

Have you applied before?

Participant Information

Name

Address Type

Street Address

Apt / Suite / Other

City

State

Zip

Select your Gwinnett County Commission District

Click here for Commission District Map

Mailing Address (if different from Home/Business address):

Street Address

Apt / Suite / Other

City

State

Zip

Phone

Alternate Phone

Email Address

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 at least one

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

I am an employee of Gwinnett County Government

(Must have approval from immediate supervisor to participate)

Department Name

Supervisor Name and Title

Can you attend all classes?

If no, which dates?

View Schedule

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?

Why do you wish to participate in the Citizens Academy?

What services or government functions are you primarily interested in learning more about?

Please list any community involvement in the past 5 years?

Education history

Please list any leadership positions you've (currently/previously) held in Gwinnett County

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

Apt / Suite / Other

City

State

Zip

Relationship to you

Phone

Alternate Phone

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

T-shirt size

T-shirt size Other

Enter T-shirt size if not found in the list

Text Verification

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Citizens Academy Community Outreach Program Application Form

Citizens Academy Application

Participant Information

Mailing Address (if different from Home/Business address):

Eligibility & Attendance

Emergency Contact Information

Additional Information