Citizens Academy Application

To be considered for participation in the Citizens Academy, an applicant must be over the age of 18 and either live or work in the city of Clearwater. Class size is limited.

I. Personal Information

Do you have a "protected address" for yourself, your spouse or children to keep your residence address and telephone numbers confidential?*

To learn more about what constitutes a protected address, visit the Pinellas County Supervisor of Elections Page.

Yes, I do

No, I don't

If yes, select one of the following:*

Yes, I am an active or former Law enforcement personnel, including correctional and correctional probation officers

Yes, I am personnel of the Department of Children and Family Services whose duties include the investigation of abuse, neglect, exploitation, fraud, theft, or other criminal activities.

Yes, I am personnel of the Department of Health

Yes, I am personnel of the Department of Revenue or local governments whose responsibilities include revenue collection and enforcement or child support enforcement.

Yes, I am a firefighter, certified in compliance with F.S. 633.35.

Yes, I am a current or former Justices of the Florida Supreme Court, district court of appeal judges, circuit court judges and county court judges.

Yes, I am a current or former prosecutors (state attorneys, assistant state attorneys, statewide prosecutors, or assistant statewide prosecutors).

Yes, I am a current or former public defenders, assistant public defenders, criminal conflict and civil regional counsel, and assistant criminal conflict and civil regional counsel.

Yes, I am a current or former human resource, labor relations, or employee relations directors, assistant directors, managers, or assistant managers of any local government agency or water management district

Yes, I am a current or former United States attorneys and assistant United States attorneys.

Yes, I am a current or former Judges of United States Courts of Appeal, United States district court judges, and United States magistrate judges.

Yes, I am a current or former code enforcement officers.

Yes, I am a current or former guardians ad litem, as defined in s. 39.820.

Yes, I am a general magistrates, special magistrates, judges of compensation claims, administrative law judges of the Division of Administrative Hearings, and child support enforcement hearing officers.

Yes, I'm a current/former juvenile probation officer/supervisor, detention superintendent, juvenile detention officer/supervisor, house parents I/II/supervisor, group treatment leader/supervisor, rehabilitation therapist, or social services counselor.

Yes, I am a County Tax Collector.

Yes, I am a current or former investigators or inspectors of the Department of Business and Professional Regulation.

Yes, I am a donor or prospective donor, Cultural Endowment Program Trust Fund, Citizen Support Organizations or National Historic Landmarks (publicly owned houses).

Yes, I am a current or former impaired practitioner consultants whose duties result in a determination of a person's skill and safety to practice a licensed profession.

Yes, I am a service member who served in the armed forces, reserve forces, and National Guard after September 11, 2001.

Check which boxes best represent your status:*

Resident of City of Clearwater (Incorporated)

Resident of Unincorporated Pinellas

City of Clearwater Business Owner

Race/Ethnicity:*

Select

Gender:*

Female

Male

Non-Binary

Prefer Not to Answer

Please Note:

As part of your application, a background check is required.

How long have you lived in the city of Clearwater?*

Share why you would like to participate and what you hope to gain.*

Have you applied to Citizens Academy before and not been selected?*

Yes

If you are not selected or available to attend this session of the Academy, would you be interested in attending the next scheduled academy?*

Yes

Have you completed any other city or local agency programs? (Sheriff's Citizens Academy, Pinellas County Citizens Academy, Leadership Pinellas, FBI Citizens Academy, etc.)?*

Do you belong to or participate in a neighborhood association?*

What unique achievements, qualities or characteristics, not described elsewhere on this application, would you bring to the class?*

Please list any other business or professional organizations, board, or civic/volunteer activities in which you are involved that were not outlined in your previous answer. If you have not had the time or interest to become actively involved, what conditions have changed that now enable you to seek involvement in your community?*

II. Emergency Contact Information

Name (First and Last):*

III. Other Information

T-Shirt Size*

Shirts are unisex collared blue tees.

Select

Do you have any dietary restrictions?*

Yes

If Yes, please list:*

Are you willing and able to attend a minimum of 8 of 10 classes? A minimum attendance of 8 classes is needed to graduate:*

Yes

Sessions occur at night at varying locations. Do you have reliable transportation to get you to and from sessions?*

Yes

Sessions consist primarily of walking and interactive activities. Are you comfortable doing so?*

Yes

How did you hear about our program?*

Select

If Other, please explain:*

Send me a copy of my responses