2. 

3. 
   

   
   

   City of Tarpon Springs

   Citizens Academy Application

   
   

   
   

7. Name
9. Address
11. City
12. State
13. Zip Code
15. Phone Number
16. Email Address
18. Occupation
19. Employer Name
21. Type of Business
22. Years Worked There?
24. How long have you lived in Tarpon Springs
28. Please indicate why you would like to participate and what you would hope to learn from this program.
30. Are you willing and able to attend a minimum of 7 of 9 classes?
    -- Select One --YESNO
31. Are you available should a special class session be necessary?
    -- Select One --YESNO
33. Do you feel you understand the purpose of the Citizens Academy?
    -- Select One --YESNO
37. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) you may still be required to provide a traditional signature at a later date.

    1. I agree.
39. Date
    Date
Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

* indicates a required field