All About Wilson: a Citizens Academy

“All About Wilson”: A Citizens Academy - 2016

“All About Wilson” is a series of interactive classes designed to teach participants about City government and to develop future leaders through well informed and civically engaged residents. To be considered for the fall 2016 session, fill in the information requested below and return it by 5 p.m. on August 31, 2016. For more information on “All About Wilson”, call 296-3398.

Full Name ______

Mailing Address ______City ______Zip ______

Home Phone ______Business Phone ______Cell Phone ______

Email Address ______

Employer Name & Address ______

______

Please list your City Council District (1-7) if you know it (this information is not required): District ______

Are you currently a member of any City of Wilson Board or Commission?  Yes  No

If yes, which one(s)? ______

Are you interested in serving on a Board or Commission?  Yes  No

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

Organization Years as Member Position Held

______

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

______

How did you hear about the Citizens Academy? ______

The Citizens Academy will be held on Tuesday evenings from 5:30p.m. - 8:30 p.m. – September 13 through November 8. Will you be able to attend all 8 classes?  Yes  No

How long have you been a Wilson resident? ______

Optional: To ensure that we reach a cross section of our community, and for statistical purposes, please describe your: Gender: Ethnicity: Age: 18-30  31-50  51-70  71 or over 

Do you need any special accommodations?  Yes  No

Return this form by August 31, 2016 to: City of Wilson Office of the City Manager P. O. Box 10 Wilson, NC 27894-0010