Houston Regional Leadership Academy
First Name *
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Last Name *
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Email Address *
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City & State of Residence *
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Gender *
Employer *
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Occupation *
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Ethnicity *
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Party Affiliation *
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Are you currently an elected official? *
What is the office?
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What city or region do you represent?
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What year were you first elected?
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How many terms have you served in your current office?
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How many terms have you served in your current office?
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Have you run for office unsuccessfully in the past? *
What was the office?
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What city or region were you running to represent?
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What year was the election?
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Have you ever held elected office in the past? *
What was the office?
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What city or region did you represent?
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What year was the election?
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Why did you leave office?
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Have you attended an APAICS Regional Leadership Academy before? *
What City & What Year?
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Why do you think you will benefit from attending another regional leadership academy?
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Why do you want to participate in the Regional Leadership Academy? *
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How will this program help your potential future campaign for elected office? *
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How will this program help you to better serve your community? *
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Tell us something about yourself that we will not find on your resume. *
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How did you hear about the APAICS Regional Leadership Academy? *
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Did you email your resume to anthony@apaics.org? *
There is a $25 registration fee to participate. If accepted, you will be asked to pay this small amount. *
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