Civitas Leadership Seminar Application

PERSONAL PROFILE 

Name_________________________________________

Address_______________________________________
______________________________________________
______________________________________________

Home phone____________________________________

Work/school phone_____________________________

Email address__________________________________________

EDUCATION/VOCATION/EMPLOYMENT

Current employment or place of study __________________________________________________

Undergraduate institution_______________________________________________________

Degree_______________________________Date received or anticipated________

Graduate or professional institution____________________________________________

Degree_______________________________Date received or anticipated________

TELL US ABOUT YOURSELF
     and your interest in the seminar

1. How did you hear about the Civitas Leadership Seminar?
 

2. What is your primary reason for wanting to participate in it?

3. What do you most hope to learn or gain from the program?

4. Will you be using what you learn in any teaching, pastoring, or mentoring responsibilities you have?

5. Have you ever held any public office or aspire to any such position?

SUPPORTING DOCUMENTATION

Please send a brief resume or curriculum vitae along with any other information about yourself that would be helpful to us in serving you.

Mail application to:

The Civitas Programs
Center for Public Justice
2444 Solomons Island Road, Ste. 201
Annapolis, MD 21401