Fillable 2020 Kannapolis 101 Application Erika Riley City of (City of Kannapolis)

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2020 Kannapolis 101 Application Erika Riley City of (City of Kannapolis)

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2020 Kannapolis 101
Application
Please return this form to:
Erika Riley
City of Kannapolis
401 Laureate Way, Kannapolis, NC 28081
Email: eriley@kannapolisnc.gov
Fax: 704-933-7463
Name: ____________________________________________________________________________________
Address: __________________________________________________________________________________________________
Phone: ___________________________________________________________________________________
Email: ____________________________________________________________________________________
(Most program information will be e-mailed)
Employer: _________________________________________________________________________________________________
Occupation: ______________________________________________________________________________________________
Briefly explain why you are interested in participating in the Citizens Academy? _______________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________________
How do you think you will benefit from participating in the Citizens Academy? ________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________________
We share your contact information with the other academy participants, unless you direct us not to.
________ Please do not share my contact information with other academy participants
________ My information may be shared with the others in academy
A meal will be provided at each session. Do you have any dietary restrictions? If, so please explain, so we can
be considerate when planning the meals. ________________________________________________________
The City of Kannapolis understands that emergencies and unexpected circumstances arise, please acknowledge by signing this
form that you are willing to make the nine-week commitment to this course and will make every effort to attend all of the
sessions. If at any time you have to stop participating, notify the coordinator ASAP.
_______________________________________________ ______________________________
Signature Date
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2020 Kannapolis 101 Application Erika Riley City of (City of Kannapolis)

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Completed 23 January 2021

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