Civitas 2010 Application

(Application available as a PDF below.)

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________
Graduate or professional institution____________________________________________
Degree_______________________________Date received or anticipated________



TELL US ABOUT YOURSELF

1. How did you hear about Civitas 2010? 


2. What is your primary reason for wanting to participate in Civitas 2010?
 
3. What do you most hope to learn or gain from Civitas 2010?

4.  What unique contribution do you hope to make to the Civitas 2010 community?
 

SUPPORTING DOCUMENTATION

Along with your application, please send the following:

1) A resume or curriculum vitae

2) $100 non-refundable deposit

3) Name of the person who nominated you for Civitas 2010. If you were not nominated, please provide the following details for an individual who can speak to your ability to contribute to the Civitas 2010 experience: name, phone, mailing and e-mail addresses, and how you know one another.

Please mail your completed application package to:
Civitas
Center for Public Justice
2444 Solomons Island Road, Suite 201
Annapolis, MD 21401