Working Families Party
New York City Council Questionnaire 2017

Candidate and Campaign Contact Information

The information that you enter in this section must be EXACTLY what appears on your designating petition and must match EXACTLY what appears on your VOTER REGISTRATION. Make sure to double check spelling and capitalization. We strongly advise you check with whomever will be coordinating your petitioning or the Board of Elections in your County before filling out this questionnaire.

NOTE: All questions marked with an asterisk are mandatory.

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* 1. First Name

Only include a middle initial or middle name if it should be included on your designating petition.

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* 2. Middle Name or Initial

Again, this information will be EXACTLY what will appear on your designating petition.

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* 3. Last Name

Suffix (only if it should be included on your petitions):

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* 4. Name Suffix

Phone Numbers

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* 5. Cell Phone

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* 6. Home Phone

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* 7. Work Phone

Email Address (Non-Government): This must be the candidate's email address and not a staffer's

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* 8. Email Address (Non-Government)

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* 9. Confirm Email Address (Non-Government)

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* 10. CANDIDATE’S LEGAL RESIDENTIAL ADDRESS FOR PETITIONING PURPOSES:

(Again, this information will appear on your designating petition and must match the residential address that appears on the candidate’s voter registration EXACTLY.)

Street Address where the candidate is registered to vote

Registered Apt # (Only if this appears on your registration)

Registered City

Registered State

Registered Zip

Registered County (i.e. Kings)

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* 11. MAILING ADDRESS (if different than your legal residential address above)

Mailing Street Address

Mailing Address 2

Mailing City

Mailing State

Mailing Zip

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* 12. WORK ADDRESS

Employer's Name

Profession

Work Street Address

Work Address 2

Work City

Work State

Work Zip

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* 13. CAMPAIGN HEADQUARTERS ADDRESS

Campaign Headquarters Street Address

Campaign Headquarters Address 2

Campaign Headquarters City

Campaign Headquarters State

Campaign Headquarters Zip

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* 14. Campaign Manager Info

Campaign Manager Name

Campaign Manager Cell Phone

Campaign Email

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* 15. Which address should your endorsement paperwork be sent to?

6% of survey complete.

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* 1. First Name

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* 2. Middle Name or Initial

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* 3. Last Name

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* 4. Name Suffix

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* 5. Cell Phone

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* 6. Home Phone

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* 7. Work Phone

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* 8. Email Address (Non-Government)

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* 9. Confirm Email Address (Non-Government)

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* 10. CANDIDATE’S LEGAL RESIDENTIAL ADDRESS FOR PETITIONING PURPOSES:(Again, this information will appear on your designating petition and must match the residential address that appears on the candidate’s voter registration EXACTLY.)

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* 11. MAILING ADDRESS (if different than your legal residential address above)

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* 12. WORK ADDRESS

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* 13. CAMPAIGN HEADQUARTERS ADDRESS

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* 14. Campaign Manager Info

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* 15. Which address should your endorsement paperwork be sent to?

* 10. CANDIDATE’S LEGAL RESIDENTIAL ADDRESS FOR PETITIONING PURPOSES:

(Again, this information will appear on your designating petition and must match the residential address that appears on the candidate’s voter registration EXACTLY.)