EmailMe Form - Candidate Filing Form

Candidate Filing Form - Olympic Park

Neighborhood Council Elections

ATTENTION: All candidates whose names will appear on the ballot must complete and submit this form with the Department of Neighborhood Empowerment by MIDNIGHT on October 29, 2012. Any forms received after this day will not be processed. There are no write-in candidates. Candidates must provide documentation and any other applicable identification to establish their stakeholder status for the position for which they are applying by this deadline, otherwise their filing will not be complete. For more information regarding this form and acceptable forms of documentation, please go to www.EmpowerLA.org or call (818) 293-VOTE (8683).

CANDIDATE INFORMATION *
First Last
Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region
Phone *
### - ### - ####
Email *
I AM A NEIGHBORHOOD COUNCIL (NC) STAKEHOLDER WITHIN THE BOUNDARIES OF:
Please select neighborhood council field
I'M AN NC STAKEHOLDER BECAUSE:
I AM A RESIDENT OF THE NC
I OWN PROPERTY IN THE NC
I WORK IN THE NC
I OWN A BUSINESS IN THE NC
See address above
Different Address:
Type in address if different from above:

Street Address City State / Province / Region Postal / Zip Code Country / Region
Name of Business
Name the place of employment
Property Address

Street Address City State / Province / Region Postal / Zip Code Country / Region
I'm a Stakeholder because:
I HAVE A VESTED INTEREST IN THE NC BASED ON THE FOLLOWING FACTUAL BASIS:
I'm a Stakeholder because:
OTHER
If none of the other options apply from above, please check OTHER and describe why you are a Stakeholder below:
Address

Street Address City State / Province / Region Postal / Zip Code Country / Region
I QUALIFY AND AM APPLYING FOR THE FOLLOWING NC BOARD SEAT: *
*
I DECLARE UNDER PENALTY OF PERJURY THAT THE ABOVE STATEMENTS ARE TRUE AND CORRECT:
Upload your Candidate Documentation:
(Refer to http://www.slideshare.net/EmpowerLA/empower-la-elections-documentation for acceptable forms of documentation. Either upload here or submit to your Election Administrator)
Upload your Candidate Documentation (if applicable):
(Refer to http://www.slideshare.net/EmpowerLA/empower-la-elections-documentation for acceptable forms of documentation. Either upload here or submit to your Election Administrator)
Upload your Candidate photo here:
Please upload a .jpg only file. Maximum of 2MB allowed.
Today's date *
MM / DD / YYYY
Please type in your Candidate Statement here:
(* Must not exceed 150 word count limit (including translation(s)); * Must be submitted no later than by MIDNIGHT October 29, 2012.
(All candidates have the option of submitting a Candidate Statement and picture as part of their Candidate Filing application. Every candidate must adhere to the following guidelines when submitting a Candidate Statement:
• Must not exceed 150 word count limit (including translation(s));
• Must be submitted no later than by MIDNIGHT October 29, 2012; and,
• May not include any pictures, profanity or comments about any other candidate.
A candidate may submit translated version(s) of the original statement, which must comply with all aforementioned criteria. Candidate Statements will be available on the Neighborhood Council page that the Candidate is running for and at the polling place on Election Day.)
Image Verification

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