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Application Form

* Required
Title
First Name *	Last Name *
Home Address *	City *
State *	Zipcode/Postcode *
Country *
Email Address *	Cell Phone Number *
Home Phone Number *	Date of Birth *

Pastoral/Clergy Recommendation Info:
Name of Pastor/Clergy Leader *	Church Name *
Phone Number *	Email *
Address *	City *
State *	Zipcode/Postcode *
Country *

What area of civic leadership are you interested in?	What is your career goal?

Why are you interested in participating in City Action Coalition Institute?	Do you have a person you want to emulate in your career path? If so, who is it and why?

To complete your application, please attach or send a recommendation from you pastor or clergy leader that officially releases you to participate in our training sessions. This letter should be on the letterhead of your local church. Attach File (100Mb Limit *)

Payment Method * Mail PayPal	Amount ($25 per session) *

Covenant Commitment
All applicants must agree to this covenant commitment: * I commit to use the knowledge I receive in these trainings to serve my community as salt and light of the glory of God. I commit to be faithful in prioritizing and attending these trainings to the best of my ability. Also, I have successfully obtained the blessing of my pastor or clergy leader to represent my church. Yes
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