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TEA Delegate Nomination Form

This form is designed to gather nominations of those interested in serving as a delegate to the Tennessee Education Association Representative Assembly.

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Last Name

Last Name

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First Name

First Name

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Contact information

Contact information School/Work Site:
Home Address:
Address 2:
City/Town:
State:
ZIP:
Home Email Address:

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Phone numbers

Phone numbers cell
home
work
work extension

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Have you served as an TEA delegate in the past?

Have you served as an TEA delegate in the past? Yes.

No.

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NEA member number or MNPS employee ID number.

NEA member number or MNPS employee ID number.

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How would you describe your position?

How would you describe your position? Teacher

Administrator/Supervisor

Education Support

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Are you an ethnic minority?

Are you an ethnic minority? Yes

Prefer not to answer

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Please respond.

Please respond. By submitting this form I am acknowledging I am an MNEA member in good standing. All of the information provided above is accurate to the best of my knowledge.

TEA Delegate Nomination Form

*Last Name

*First Name

*Contact information

*Phone numbers

*Have you served as an TEA delegate in the past?

*NEA member number or MNPS employee ID number.

*How would you describe your position?

*Are you an ethnic minority?

*Please respond.