Nomination Form 2012

Massachusetts Community College Council

On-line Nomination E-Form - 2012 - Tuesday, May 22, 2012 - 8:07 am

A candidate must file this form (or the printed form) with the MCCC Elections Committee
so that it arrives by
Thursday, February 2, 2012, 4 p.m.
Nomination papers that arrive late will not be accepted.

Most fields below are REQUIRED. These are indicated with Underlining.

Check all that apply.

MTA DELEGATE Candidate

MTA Annual Meeting Delegate
(Boston: May 11 and May 12, 2012)

NEA DELEGATE Candidate

NEA Representative Assembly Delegate
(New Orleans: June 30 - July 5, 2012)

Candidates for NEA/RA may submit biographical statements. See below

OFFICER Candidate *

	President
	Vice President
	Treasurer
	Secretary
Nomination for officer requires at least 50 signatures of MCCC members by the deadline for nominations *.
MCCC At-large Part-time Director Candidate*
	At Large Director Two to be elected
Nomination for at-large part-time director requires at least 10 signatures of MCCC members by the deadline for nominations *.

* Signature Form for Candidates for Officer or At-large Part-time Director

Name


First Name	Initial	Last Name

Home Address

Address 1

Address 2


City	State	Zip(5)

Home Tel #

- -

College

Work Tel #

- - x

Primary MCCC Membership:

Full Time DCE Part Time Day

Sex:	Female Male

Ethnicity:

Black Asian Pacific Islander Caucasian
Hispanic - Chicano Native American

Optional Bio or Statement for NEA Representative Assembly Candidates only
NEA Rep bio or statements are provided with the ballots.
If you are not an NEA Rep. Candidate, this information will NOT be used.

50 word limit - Will be formatted as one paragraph.

Word Count (50 maximum) Words above 50 will be deleted.

Email address:
Note: If the Email address is not filled in correctly we cannot email a copy of your electronic submission back to you. No other copy will be returned to you.

After submitting this form, you should receive (1) a report on your browser window and (2) an automatic email reply. This confirms that an email with your nomination was sent to the MCCC office, which keeps track of nominations.
If you wish, you can obtain further confirmation that your nomination has been received by sending an email request to .

Deadline for Completed Applications to be RECEIVED : Thursday, February 2, 2012, 4 p.m.

Notice: To minimize any chance of a lost nomination, a copy of this electronic document is emailed to the

Nominations Committee Chair
MCCC Office
MCCC Web Site Coordinator (Treasurer)
Sender

Return to the MCCC Home Page WITHOUT submitting this information