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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

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* First Name

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* Contact information

School/Work Site: *

Home Address: *

Address 2:

City/Town: *

State: *

ZIP: *

Home Email Address: *

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* Phone numbers

cell

home

work

work extension

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

Yes.

No.

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* NEA member number or MNPS employee ID number.

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* How would you describe your position?

Teacher

Administrator/Supervisor

Education Support

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* Are you an ethnic minority?

Yes

Prefer not to answer

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* 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.