Citizens Academy Application

Phone Number

Address

Address or Location

DOB [MM/DD/YYYY, i.e. 01/31/1980]

CDL / CID

Ontario Resident

Yes

Email Address

Occupation

How Long?

Name and Address of Employer

Have you had any arrests or convictions which you believe might disqualify you from participating in the Citizen's Academy?

Yes

Please explain your arrests and/or convictions.

List community interest, clubs, professional memberships, etc.

How did you hear about the Citizen's Academy

Personal Reference #1. Known at least one year, not a relative.

Name

Years Known

Personal Reference #1 - Address & Phone

Address

Phone

Personal Reference #2. Known at least one year, not a relative.

Name

Years Known

Personal Reference #2 - Address & Phone

Name

Phone

Personal Reference #3. Known at least one year, not a relative.

Name

Years Known

Personal Reference #3 - Address & Phone

Name

Phone

What are your reasons for wanting to attend the Citizen's Academy

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.