Mayor’s Citizens Institute is a free, 10-week experience in which a
group of approximately 25 Akron residents will meet evenings, once a
week (Aug.–Oct.) to engage with City departments and leaders; while
learning more about city programs and services, responsibilities to
taxpayers, and our charter form of government. Applicants must be 18
years of age, or older, and residents of Akron.
Applications are due on, or before June 24, 2019.
2019 MAYOR'S CITIZENS INSTITUTE
APPLICANT NAME AND ADDRESS
Name:
Date of Birth: _____ /______ /__________ Years living in Akron:
Phone:
Current address:
City: State: ZIP Code:
Have you ever been homeless? I live in Ward: Email:
PERSONAL INFORMATION
Ethnicity: Gender:
Check all that apply: EMPLOYED UNEMPLOYED COMMUNITY VOLUNTEER SELF-EMPLOYED RETIRED
Em
ployer’s name:
Volunteer Organization(s) and Other Affiliations:
WHY DO
YOU WISH TO PARTICIPATE IN THE MAYOR’S CITIZENS INSTITUTE?
*Feel free to use back of form, or attach a document (500 words or less)
Interests, boards, volunteer activities, vision for your city and/or neighborhood(s)
REFERENCES
(*PLEASE PROVIDE TWO)
Name Address Phone
1.
2.
SIGNATURE
I authorize the verification of the information provided on this form. I have received a copy of this application.
Signature of applicant: Date:
Note: City of Akron Employees are not eligible to participate
Return to: Mayor’s Citizens Institute
City of Akron
C/O Summer Hall
166 S. High Street
Suite 200
Akron, Ohio 44308
330/375-2376
FAX 330/375-2468
Email Mayor@akronohio.gov
