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February 15, 2008

Citizen Academy Application

Name:
Street Address:
City, State, Zip:
Phone Number:
Email Address:
Your Birthdate:
Are you a U.S. Citizen?
Your Driver's License Number and State:
Your Race (optional):
Your Gender (optional):
Your Employer:
Your Occupation:
Your Employer's Address and Phone Number:
Organizations or Club Memberships:
How did you hear about the Citizens Academy?
Why are you interested in attending?
Have you ever been convicted of a crime? If so, please give details.

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