Citizens' Academy Application

Name:
E-mail:
Address:
City:
Zip Code:
Home Phone:
Work Phone:
Birthday:(mm/dd/yyyy)
Ethnicity:
Gender:		M F
Are you currently a member of a Sheriff's Advisory Council (ShAdCo):		Yes No
Are you currently a member of a civic group? (i.e. CPAC, MPO, Rotary, Civitan, Jr. League?) Please list:
How did you find out about Citizens' Academy

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