Citizens Academy Application

2. City of Cocoa Citizens Academy Application
   The City of Cocoa is proud to offer a Citizens Academy program which will give citizens a greater insight into the various services and functions of local government. Please fill out the following information completely. This program is open to all City of Cocoa residents and business owners ONLY.

   The City of Cocoa is proud to offer a Citizens Academy program which will give citizens a greater insight into the various services and functions of local government. Please fill out the following information completely. This program is open to all City of Cocoa residents and business owners ONLY.

4. Application Deadline
   October 15, 2019

   October 15, 2019

6. Class Schedule
   The class schedule is posted on the Citizens Academy webpage. Please make sure you are able to attend each of the sessions before applying. Each participant can be excused from one session. If a participant misses more than one session, they will be removed from the program to allow room for other applicants.

   The class schedule is posted on the Citizens Academy webpage. Please make sure you are able to attend each of the sessions before applying. Each participant can be excused from one session. If a participant misses more than one session, they will be removed from the program to allow room for other applicants.

8. Program Overview and Objectives
   The City of Cocoa Citizens Academy is an 8-week program designed to inform residents and community stakeholders about the operations of city government and what is involved in delivering and maintaining services to the citizens of Cocoa. The program is designed for residents and Cocoa business owners that are 18 years and older who are interested in learning more about their local government and how they can get involved in their community. Class size is limited to the first twenty-five (25) Cocoa residents or business owners that apply. At the end of the program, participants should have an increased understanding of the organizational structure and operations of the various departments that impact the quality of life in the City of Cocoa. Graduates of the Citizens Academy will be prepared to have a role in the future of their neighborhoods and the City overall through government/citizen engagement.

   The City of Cocoa Citizens Academy is an 8-week program designed to inform residents and community stakeholders about the operations of city government and what is involved in delivering and maintaining services to the citizens of Cocoa. The program is designed for residents and Cocoa business owners that are 18 years and older who are interested in learning more about their local government and how they can get involved in their community. Class size is limited to the first twenty-five (25) Cocoa residents or business owners that apply. At the end of the program, participants should have an increased understanding of the organizational structure and operations of the various departments that impact the quality of life in the City of Cocoa. Graduates of the Citizens Academy will be prepared to have a role in the future of their neighborhoods and the City overall through government/citizen engagement.

10. First Name*

11. Last Name*

13. Address1*

15. Address2

17. City*

18. State

19. Zip*

21. Phone number:*

22. E-mail Address*

24. Cocoa Business Name: (If you are not a resident of the City of Cocoa but own a business or property in the City of Cocoa.)

26. Emergency Contact Information

28. Full name:*

29. Relationship:*

31. Phone number:*

33. Shirt Size:*

    Must Select One. Cotton Polo Shirts.

    1. Small
    2. Medium

    1. Large
    2. X-Large

    1. XX-Large
    2. XXX-Large
35. Briefly explain why you wish to enroll in the City of Cocoa's Citizens Academy and what you hope to gain from the experience:*

37. If you need special accommodations, please contact Samantha Senger at (321) 433-8685 or ssenger@cocoafl.org.

    If you need special accommodations, please contact Samantha Senger at (321) 433-8685 or ssenger@cocoafl.org.

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39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

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