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Citizen's Academy logoClearwater 101 Citizen's Academy Fall 2014 Class Application

You can apply online for the Citizen's Academy by completing the following form. If you have any problems applying online, please feel free to fill out and return the printable version of the application.

If you have further questions about the Citizen's Academy, please contact the Public Communications Department.

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Please fill out this form and click the 'Submit' button.
Note: Please complete ALL fields.

Name:

Mailing Address

City:

State:

Zip:

Home Phone:

Business Phone:

(Please enter "None" if you have no business phone)

E-Mail Address:

(Please enter "None" if you have no e-mail address)

I am a resident in the incorporated City of Clearwater:


I am a business owner in the incorporated City of Clearwater:


Tell us a little about yourself (past employment, organizations in which you are or have been active, special interests):

Please tell us why you would like to particpate in Clearwater 101:

What do you consider your major strengths and qualifications for Clearwater 101:

How will our community benefit from your participation in Clearwater 101:

Shirt Type:


Shirt Size:

All shirts are pre-shrunk cotton


For the safety of participants, a background check will be completed on all applicants. For that purpose, please include your:

Race:

Gender:

Date of Birth:


Application Personal Commitment:

If selected I will devote the time necessary to meet graduation requirements. If chosen, I will attend at least eight (8) of the ten (10) sessions. I will continue to stay involved in City government to the best of my ability and act as an ambassador by sharing my knowledge with other Clearwater citizens.