MCLA Application Form - Montgomery, Ohio

Name * Required
First Last
Business Name
Email * Required
Address
Street Address Address Line 2 City State ZIP
Phone * Required
Gender * Required
- Male
- Female
- Non-Binary
Date and place of birth * Required
Years living or working in the City of Montgomery * Required
Personal History - Please tell us about yourself, i.e. interests, accomplishments, community involvement, etc. * Required
Are you a member of any City of Montgomery Boards or Commissions? * Required
- Yes
- No
Please list any civic, professional, business, religious, social or other organizations in which you are a member. If you are new to Montgomery, you may include activities in your prior location.
In your opinion, what is the difference between being a "resident" and being a citizen?
Briefly discuss what you hope to learn as a participant in the Citizens' Academy program and how you anticipate using the information.
Do you have any special areas of interest or anything you would like to learn more about related to local government?
Are you planning to attend all sessions?
- Yes
- No
How did you hear about the Montgomery Citizens' Leadership Academy?
Permissions * Required
I hereby give my permission for the City of Montgomery to use any still photograph or video footage in which I may appear for whatever purpose(s) deemed appropriate. I do this voluntarily and with the understanding there is no remuneration.
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