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2. First Name*
3. Last Name*
5. Age*

   *Must be 18 or older

6. Phone Number*
7. Email*
8. Preferred Method of Contact*
   -- Select One --CallTextEmail
10. Address*
12. City*
13. State*
14. Zip Code*
16. Occupation*
17. How long have you been a La Vergne resident or business owner?*
19. Do you have prior experience in City government, such as serving on a board or committee? If yes, please explain.*
21. Please describe your present and past community involvement, i.e. voluntary, social, business, and professional.*
23. Briefly describe why you are interested in participating in the Citizens Government Academy.*
25. Contact Public Information Officer Anne Smith with any questions.

    (615) 287-8690 or email asmith@lavergnetn.gov

26. I understand that this is an application for the La Vergne Citizen's Government Academy and does not guarantee me a spot in the class.*

    1. I understand
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28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field