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Citizens Academy Online Application
Citizens Academy Homepage

City Council

2012 Citizens Academy Application Form

Deadline to Register: Fri., Dec. 16, 2011, at 5 p.m.

Please complete the form below. To fill it out, simply place your cursor in the space provided for Name, then press the Tab key to advance to all remaining form fields. Once the application has been completely filled out, hit the Submit button to send information to Midland City Hall. If you need to start the form over, select the Reset button and begin again.

SPECIAL NOTE: Please refrain from pressing the "Enter" key on your computer keyboard as you work on the application, as this could send the form to the City of Midland before it is complete.

Because space is limited, not all who apply will be able to participate in the 2012 academy. If you are selected to be in the class, you will be notified by a City staff member by early January 2012. Priority will be given to citizens who live in the city of Midland.

***Items with an asterisk (*) must be filled in completely in order to submit the online application.***

City of Midland Citizens Academy
Name:*
Mailing Address:*
City:*
State:*
Zip Code:*
Best Phone Number to Reach You:*
E-Mail Address:
City ward in which you live*	(Select an option from dropdown list; select Live Outside City if you are not a resident of Midland. Not sure which city ward you live in? Click here for a Midland ward map.)
Please list any civic activities in which you participate:
Why are you interested in participating in the Citizens Academy?
Are you a resident of the city of Midland?*
How did you learn about the program?