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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* 3. Circulator School:

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* 4. Circulator  Date of Birth:

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  


(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: _________________________________
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