District 10 Nominating Form

Please fill out the following form

Submitted by (required):

Email Address of Nominator (required):


Please provide information about the nominee - You may nominate yourself or another person.

Nominee’s Name:

Nominee’s email address:

Address:

City:

Zip:

I wish or my nominee wishes to be considered for the following position(s)
DirectorAssistant DirectorSecretaryTreasurer


Please give a brief description for nomination:

PTA experience (positions held at local, council, district or state level)

Qualifications for this office:

Professional and/or other volunteer experience:

References: Include at least three references who have seen the volunteer work of the nominee.
1. Name:
Phone:

2. Name:
Phone:

3. Name:
Phone: