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Government Citizens Academy Application

* Required 


Applicant name *


Applicant address *


Applicant phone *


Applicant email *


You will automatically receive the county's e-newsletter, Weekly Update, and information about your district 

Are you a current or former employee of Chesterfield County? *


If yes, indicate department name


In which Magisterial District do you live? *


Government Citizens Academy

Indicate your first choice of when you would like to attend the Government Citizens Academy *


What is your interest in the Chesterfield County Government Citizens Academy and what do you hope to learn from attending?


Emergency contact

Emergency contact name


Emergency contact phone


I acknowledge video and still photos will be taken during the academy and may be used in county promotions *