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4. CITY HALL CITIZENS ACADEMY ONLINE APPLICATION
   Please fill out the form completely before submitting it. ALL information is required. If a blank does not apply, type "NONE" or "N/A." Applicants must be 18 years of age or older.
6. Full Name (First Middle Last):*
7. Date of Birth (MM/DD/YYYY):*
9. Street Address:*
10. City, State, Zip Code:*
12. Contact Phone # (xxx-xxx-xxxx)*
13. Email Address:*
15. Drivers License State and Number:*
16. SSN (Last Four Digits ONLY):*
18. Current Employer:*
19. Position:*
21. Work Supervisor:*
22. Work Phone # (xxx-xxx-xxxx)*
24. Personal Reference 1 - Name:*
25. Personal Reference 1 - Phone #*
27. Personal Reference 2 - Name:*
28. Personal Reference 2 - Phone #*
30. Have you ever been arrested, convicted, or cited for any crime other than a traffic offense*

    1. YES
    2. NO
32. If YES, please explain and provide dates:
34. Are you a city employee?*

    1. Yes
    2. No
36. How did you hear about this class*
37. If referred, by whom
39. Please indicate any prior civic involvement with the City of Wichita Falls?
41. Why do you wish to participate in the Citizens Academy? What do you expect to learn?
43. Please note this class in limited to 25 individuals and is first come first serve. Applicants must also sign and return the Background Inquiry Form to complete their application.
45. For more information, please contact Public Information Office at (940) 761-7401
Leave This Blank:


47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit

* indicates a required field