2019 Student Election Circulator

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

Question Title

* 1. Candidate Name:

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* 2. Circulator Name:

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* 3. Circulator School:

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* 4. Circulator Date of Birth:

Date / Time

Date

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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:
nhpsstudentvoice@new-haven.k12.ct.us

Signature:

Date:

(OFFICE USE ONLY) Circulator Eligibility Verification

Name

Date

System Used circle one

(SchoolNet,PowerSchool)

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: _________________________________

2019 Student Election Circulator

Office SoughtStudent Member, New Haven Board of Education

Question Title

* 1. Candidate Name:

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* 2. Circulator Name:

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* 3. Circulator School:

Question Title

* 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

Question Title

Office Sought
Student Member, New Haven Board of Education