Citizens University Application

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* 1. Contact Information:

Name (First & Last)

Address

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 2. Date of Birth:

Date:

Date

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* 3. Employer (past or present)

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* 4. Occupation, profession or field of study

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* 5. Are you a registered voter?

Yes

No

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* 6. Why do you want to participate in Citizens University?

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* 7. List any current community involvement activities:

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* 8. What questions would you like answered regarding the City of College Station?

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* 9. How did you hear about Citizens University?

E-mail

Friend

Facebook

Twitter

Channel 19

Other (please specify)

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* 10. The following guidelines are in place to ensure that each and every participant has an enjoyable and educational time.

If you miss more than three sessions, you will not receive a graduation certificate.

If you know you cannot make a session or need to drop out of the program, contact the program coordinator.

Outside guests (including children and pets) are not allowed to attend sessions, unless it has been approved by the program coordinator.

Cell phones should be on silent and placed out of sight during sessions.

This program is not intended for a time to air grievances or issues with city staff. If you have a personal question or issue, please contact staff outside of the session.

Be kind and respectful to your fellow participants and presenters.

Last but not least, HAVE FUN!

I Understand and Agree