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2. Full Name*
3. Date of Birth*
   Date of Birth
5. Contact Phone Number*
6. Email Address*
8. Full Address*
10. Occupation
12. Please explain why you are interested in attending the Citizen's Fire Academy and what you hope to gain from it.
14. Please provide any additional information that you think would make you a good candidate for this program.
16. Do you have any civic or group affiliations?

    1. Yes
    2. No
17. If "Yes," please list them:
19. The Citizen's Fire Academy meets every Thursday from 6:00 PM - 9:00 PM. There is one Saturday class during the final week. Would you be able to commit to attending these sessions?*

    1. Yes
    2. No
20. If you answered "No," please explain.
22. Shirt Size*

    1. Small
    2. Medium
    3. Large
    4. Extra Large
24. Electronic Signature Agreement*

    I understand that any omitted or false answers will be grounds for my application being rejected. I affirm that all of my answers are complete and that I completed this application myself. I understand that participation in this program is voluntary and that the Hingham Fire Department will make the final determination on applicants to this program.

    1. I agree
26. Electronic Signature
27. Date
    Date
Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

* indicates a required field