Contact Information: 

Name: Shirt Size:
Address:
City: State: Zip:
Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin
Home Phone: Business Phone:
Email:

Employer Information: 

Employer Name:
Employer Address:
City: State: Zip:
Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin

Please list your City Council District
(please call 373-2489 if you do not know your district):

Are you currently a member of any City of Greensboro Board or Commission? YesNo
If yes, which one(s)?


Are you interested in serving on a Board or Commission? YesNo

Organization Information

Please list any civic, professional, business, religious, social, or other organizations of which you are a member. If new to Greensboro, you may include activities in your prior location.

Organization Years as Member Position Held

Briefly discuss what you hope to learn as a participant of the City Academy and how you plan to use the information.


How did you hear about the City Academy?

The City Academy will be held on Thursday evenings from 6 to 9 pm – September 7 through November 9. Will you be able to attend all 10 classes? YesNo

How long have you been a Greensboro resident?

Did you apply to the City Academy last year? YesNo

To ensure class diversity and for statistical purposes, please answer the following:

Gender: MaleFemale
Race:
Age: 18-3031-4041-5556-70over 71
Do you need any special accomodations? YesNo