Required fields are marked with asterisks (*)

Citizens Academy Application

Thank you for your interest in learning more about your local government and how the City of Madera serves the community.

The City of Madera Citizens Academy gives residents an inside look at how local government works, including City operations, services, and programs. Participants will learn how decisions are made and discover ways to become more engaged in their community. Complete the application below to be considered for the upcoming Citizens Academy. We look forward to welcoming you.

Name:

Email:

Address:

Phone:

Employer:

Occupation:

Since applicants will be selected to represent different geographical areas of the city, please provide the nearest major cross streets to your residence.

How long have you lived in Madera? If new to Madera, in what city did you previously reside?

Why would you like to participate in the Citizens Academy?

What topics do you hope to learn more about?

What do you feel are some of the major challenges for Madera?

What do you like most about Madera?

Would you be able to commit to attending all sessions of the academy?

Please advise of any special dietary restrictions:

Do you require any physical accommodations to participate fully?

What is your polo shirt size? Please indicate your preferred size and gender-specific fit (e.g., men’s or women’s).

Please designate an emergency contact: (Name, Relationship, and Phone Number)

By submitting this application, I acknowledge that participation in the City of Madera Citizens Academy program is voluntary. I understand that information provided in this application may be used by the City of Madera for the purpose of evaluating and administering the program.

Signature:

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