[Cobb County Government] Cobb 101 Application

Applicant Information

This academy is an eleven-week course designed to provide an in-depth look at the many functions of county government. It will be held at various government buildings throughout Cobb County, allowing participants to experience what the Cobb County government does for our residents. Participants are allowed to miss only one class during the 11-week course.

The class will be limited to 32 participants who are Cobb residents or business owners. You must be 18 years or older to participate. Those who are running for office or currently an Elected Official are ineligible to participate.

Please complete the application in its entirety. Sections starred are mandatory for completion of the application.

Commission District*

* To determine which commission district you are in, please visit our Find Your Commissioner page.

Primary Phone Number

Alternate Phone Number

Sex

Male

Female

Birthdate

Background Information

Occupation

Name of Employer/School

Business Phone Number

How long have you lived in Cobb County? (must be a Cobb County Resident)

How long have you worked in Cobb County?

Briefly explain why you are interested in Cobb101

Educational Background

Civic Activities

Program Information

How did you find out about the Citizens Government Academy?

Have you previously participated in other types of citizens academies?

Yes

Have you previously applied to Cobb 101?

Yes

Emergency Contacts

Emergency Contact #1

Phone Number

Emergency Contact #2

Phone Number

Signature

Sign Here

First Name

Last Name

Choose how to sign

Draw Type