R.O.C.K. Academy Application

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Welcome to the R.O.C.K. Academy Application Form!

Join us for an engaging six-week journey as we explore the inner workings of the City of Little Rock's government. Each Monday from 5:45pm-7:15pm, we will delve into informative sessions, featuring a hybrid format facilitated in English (with a future goal of Spanish translation). Participants aged 18 and above will benefit from both in-person and virtual classes, gaining valuable insights into our city's governance and operations. Don't miss this opportunity to become an informed and empowered citizen!

The information contained in this application will be provided to the City of Little Rock Office of Executive Administration (OEA). By applying, you acknowledge and understand that OEA relies on the information provided in this application to make admission decisions for R.O.C.K. Academy. Completion of the application does not guarantee acceptance in R.O.C.K. Academy. You agree to notify OEA by writing or calling in the event of any change to the information provided in this application (phone number, address, etc.) If you do not notify OEA as required above, or if any of the information you provide is inaccurate or incomplete in any aspect, OEA may deny your application and you will not be considered for admission in R.O.C.K. Academy.

An * (asterisk) means the question is required and if it is not completed, your application cannot be processed.

By completing this application, I give my consent for the City of Little Rock to use photographs, audio and video of me for advertising purposes in perpetuity and without prior notice.

Email *

Record my email address with my response

Name (First and Last) *

Age (What is your age?) *

18-24 years

25-34 years

35-44 years

45-54 years

55-64 years

65+ years

Race/Ethnicity (With which race/ethnicity do you most identify?) *

Black/African American/African

Hispanic, Latino/a/e, or Spanish

Middle Eastern/North African

Asian/Asian American

American Indian or Alaska Native

Native Hawaiian or Pacific Islander

White

None of the above (please specify)

Other:

Sex (What sex were you assigned at birth?) *

Non-binary

Female

Male

Prefer not to say

Gender (What is your gender?) *

Woman

Man

Non-binary, trans, or another gender

Prefer not to say

Address (street, city, state, zip code) *

Phone number *

Email *

Preferred method of contact

Phone

Other:

Clear selection

How did you hear about ROCK Academy? *

City of Little Rock Website

Social Media

Radio

Other

Additional information

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms