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2. 
3. Apply for the Park Forest Civic Leadership Academy!

   Please complete the below application to be considered for enrollment in the Park Forest Civic Leadership Academy. Completed applications, including all accompanying documents, must be submitted by August 4. Applicants will be notified of the status of their application in mid-August.

5. First Name*
6. Last Name*
7. Work Phone
   If no work phone leave blank.
8. Cell Phone*
10. Address1*
12. City*
13. State*
14. Zip*
16. Email Address
17. How many years have you lived in Park Forest?*

    1. 0
    2. 1-3
    3. 4-7
    4. 8-10
    5. 11-20
    6. 21-30
    7. 31-40
    8. Over 40
21. Age Group*

    1. 16-21
    2. 21-29
    3. 30-39
    4. 40-49
    5. 50-59
    6. 60-69
    7. 70+
22. Gender*
    -- Select One --FemaleMale
23. Racial or Ethnic Group*
    -- Select One --American Indian/AlaskanAsian/Pacific IslanderBlack/African-AmericanHispanic/LatinoWhite/CaucasianOther/Choose Not To AnswerBiracial/Multiracial
24. Employment Status*
    -- Select One --Employed full-timeEmployed part-timeNot employed/student/retired
26. What is your background in Park Forest? Have you had any involvement in the community over the years? If so, please tell us about it. *
28. What are you hoping to get out of your participation in the Park Forest Civic Leadership Academy? *
30. Please select your current or future career field*
    -- Select One --Arts & HumanitiesCurrently RetiredEnvironment/AnimalsFaith-basedHealthGovernment AgencyCommunity DevelopmentEducationFoundationHuman/Social ServicesStudentOther
32. Organization Employed By / School Attending*
33. Education
    -- Select One --Some High School (non-graduate)High School (graduate)Some College (non-graduate)College (graduate)Post Graduate (non-graduate)Post Graduate (graduate)Other
35. How did you hear about the program?
    -- Select One --Cable Access ChannelCommunity CalendarDiscover MagazineElectronic Message BoardFacebook/TwitterFriend/Word of MouthSchool CounselorSupervisor/TeacherWebsiteOther
36. Though not required, if you would like to upload your resume, click here to attach it to your application
40. Application Statement
    If accepted to the Park Forest Civic Leadership Development Program, I understand that my attendance at and full participation in all scheduled sessions is required. I also understand that I may be expected to complete assignments. I am responsible for the balance due for my participation prior to start of the program. A certificate documenting my participation and graduation will be provided at the program’s conclusion.
42. Electronic Signature
    Please print your signature on this line to finalize your application.
Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit

* indicates a required field