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Office Sought
Student Member, New Haven Board of Education

Circulators are individuals who gather signatures on the petition forms. The circulator maybe the candidate or a representative appointed by the candidate.
Election Date: April 29th, 30th, May 1st, 2020

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* 1. Candidate Name:

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* 2. Circulator Name:

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* 4. Circulator  Date of Birth:


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* 5. Circulator Student ID #

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* 6. Circulator Email:

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* 7. Circulator Phone Number

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* 8. Statement of Authenticity: I certify that all signatures on this page are authentic originals, which were signed in my presence by New Haven public high school students.  Furthermore, I certify that there are no copies or duplicate signatures, to the best of my knowledge.

You will receive confirmation of receipt from:  

(OFFICE USE ONLY) Circulator Eligibility Verification


System Used circle one

 Statement of Verification: I hereby certify that I compared the name of the circulatorlisted above with our student information system and have verified their?

·       Name

·       Public high school enrollment

·       Birth Date


Signature: ______________________________________________


Date: _________________________________

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