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141 Pryor St. SW
Atlanta, GA 30303
404-612-4000
customerservice@fultoncountyga.gov
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Fulton County Citizens University
Fulton Citizens University Form
Fulton County Citizens' University
Application
Title
Please Select One
Miss.
Ms.
Mrs.
Mr.
Dr.
First Name
Middle Name
Last Name
Street Address
City
State
Zip Code
Home/Cell Telephone Number
Email
Gender
Male
Female
Eligibility: Participants must be residents of Fulton County, work or have a business in Fulton County, or be an enrolled student in a Fulton County college or university.
Please check all that apply:
I am a resident of Fulton County
I work in Fulton County
I have a business in Fulton County.
I am a student at a college/ university in Fulton County
CIVIC INVOLVEMENT:
Do you currently serve on a county board or commission?
yes
no
If yes, please which board/commission:
Please list any community involvement in the past 5 years.
Please list any leadership positions you've (currently/previously) held in Fulton County
PROGRAM INTEREST/GOALS:
What are your participation goal(s) for Citizens University?
What services or government functions are you primarily interested in learning more about?
How did you hear about the Fulton County Citizens' University Program?
T-Shirt Size
M
L
XL
2XL
3XL
Attendance:
Can you attend all Citizen University classes?
Yes
No
If no, which dates are you NOT able to attend:
Do you require any special accommodations to participate, including reasonable accommodations for a disability, special dietary needs, or others? Please specify.
Yes
No
If yes, please explain:
EMERGENCY CONTACT INFORMATION In case of emergency, who should we contact?
Emergency Contact Last Name
Emergency Contact First Name
Emergency Contact Street Address
Emergency Contact City
Emergency Contact State
Emergency Contact Zip code
Emergency Contact Phone Number
Emergency Contact Email Address
Fulton County is an equal opportunity employer encouraging diversity and inclusion. If you need reasonable accommodations or modifications due to a difference in ability, including communications in an alternate format, please contact 404-612-7390. For TDD/TTY or Georgia Relay Service Access, dial 711.
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