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2. Basic Information
4. First Name*
5. Last Name*
7. Email Address*
8. Phone Number*
10. Address*
12. City*
13. State*
14. Zip Code*
16. Neighborhood/Subdivision (If applicable)
18. Demographics
20. Demographics

    1. Female
    2. Male
22. Age

    1. 18-29
    2. 30-39
    3. 40-49
    4. 50-59
    5. 60-69
    6. 70-79
    7. 80+
24. Ethnicity

    1. Caucasian
    2. Black or African American
    3. Hispanic or Latino
    4. Asian or Asian-American
    5. American Indian
    6. Other
26. How long have you lived in Indian Trail?

    If you are a Town of Indian Trail business owner, please specify how long your business has been located in the Town. 

28. Additional Information
30. Do you have any civic, volunteer, or government experience? If so, please provide examples.
32. Which aeas of our Town government are you most interested in learning about or engaging with?
34. Is there anything else you'd like the Town staff to be made aware of or know about you?

    Example: Food allergies or dietary restrictions, sensitivity to noise/light, etc. 

36. How did you hear about the Citizens Academy?

    Please check all that apply.

    1. Facebook
    2. Instagram
    3. Nextdoor
    4. IT Update E-newsletter (sent weekly on Fridays)
    5. Town Hall Bulletin Digital Newsletter (monthly)
    6. Town of Indian Trail website
    7. HOA
    8. News release or newspaper article
    9. Word of mouth (friend, relative, neighbor, elected official, etc.)
38. Attendance*

    1. I agree to attend at least 7 out of 8 sessions to graduate from the Citizens Academy program.
40. Photo Release

    By checking the box below, I agree to give the Town of Indian Trail permission to use my name, photo, or quotes for promotion or other publicity for the Town of Indian Trail Citizens Academy or other Town-sponsored initiatives.

    By not checking the box, I withhold my consent for the Town to use my name, photo, or quotes for promotion or other publicity for the Town of Indian Trail Citizens Academy or other Town-sponsored initiatives.

    1. I agree to give the Town permission to use my photo
42. Liability Release Agreement

    By checking the box below, I acknowledge I am participating in the Indian Trail Citizens Academy, an educational program about local government. In doing so, I voluntarily assume all risks associated with the activities and events involved in the program conducted by the Town of Indian Trail.

    Furthermore, I release and waive any claims of liability against the Town of Indian Trail, the Union County Sheriff’s Officers, the Hemby Bridge Fire Department, and the Stallings Fire Department for any loss, damage, or injury that may result from my participation in the Indian Trail Citizens Academy.

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

    This field is not part of the form submission.

46. Submit

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