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2. Questions and Concerns

   If you have any comments, questions, or concerns about completing this form, or need assistance determining residency status, please contact the Town via email at csawyer@pittsboronc.gov or by calling Town Hall at 919-542-4621.

6. Participant Contact Information
8. Name*
9. Email Address*
11. Address of Residence or Business*
13. City*
14. State*
15. Zip Code*
17. Phone Number*
18. Enter your preferred name here (if applicable).
22. Rules, Requirements, and Schedule*

    Please check the boxes below to indicate that you have read and understand the programs requirements. You must check all of the boxes for the submission to be valid. Rules, Graduation Requirements, and Schedule can be found by CLICKING HERE.

    1. I acknowledge that I have read and understand the rules to participate in this course.
    2. I acknowledge that I have read and understand the graduation requirements.
    3. I acknowledge that I have read and understand the tentative schedule.
26. Priority Based on Residency

    Approval for applicants to participate in the PBO 101 course are prioritized based on the following priority schedule:

    1. Residents and Business Owners within the Town's Corporate Limits.
    2. Residents and Business Owners outside of the Town's Corporate Limits BUT within the Town's Extra-Territorial Jurisdiction (ETJ).
    3. Residents and Business Owners outside of the Town's Corporate Limits and ETJ BUT within Chatham County.
    4. All other participants.

    If you are placed on the waitlist based on residency, you will be notified via email.

    If you have any questions regarding your Town residency status, please reach out to the Town using the contact information at the bottom of this form.

28. Residency Selection*
    -- Select One --Residents and Business Owners within the Town's Corporate LimitsResidents and Business Owners within the ETJ.Residents and Business Owners within outside of Town and ETJ but within Chatham County.All other participants.
32. Submission Statements*

    To be placed on the list of registered participants, you must read, understand, and agree to ALL the following statements by checking the box next to each:

    1. I understand and agree that I am not officially registered for the PBO 101 course until I have completed any additional paperwork (provided by the Town after form submission).
    2. I understand and agree that I am not registered for the course until I have received official notice from the Town.
    3. I have reviewed the contact information entered above and agree to allow Town staff to use this information to send me additional materials.
    4. I have reviewed the address information entered above and agree to allow Town staff to use this information to verify residency status for registration priority.
36. Participant Commitment

    This course is offered for free to residents and business owners. As such, the Town wishes to ensure that participants who enter the program intend to participate and complete the entire program.

    As such, please enter your full name in the box above to indicate that you intend to make a full faith effort to complete the course as presented.

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38. Submit

* indicates a required field