Free appnomcc.p65 - Wyoming

Community College Board Trustee Application for Election
State of Wyoming ) ) ss. W.S. 22-22-202 County of _______________ ) I, the undersigned, swear or affirm that I was born on _______________, _____(year), and that I have been a resident of the State of Wyoming since _______________, and that I am a registered voter of the _____________ community college district (and resident of trustee residence area or subdistrict ______________, if any), residing at __________________________________________________, and I do hereby request that my name, _____________________________________________, be printed on the ballot of the election to be held on the 2nd day of November 2010, as a candidate for the office of Community College Board Trustee for a term of _____ years. I hereby declare that if I am elected, I will qualify for the office. DATED this _________ day of ____________________, 2010.

___________________________________
Print or type your name exactly as you wish it to appear on the ballot. (W.S. 22-6-111 states that professional titles and degrees shall not appear on the ballot.)

_________________________________ Signature _________________________________ Residence Address _________________________________ Mailing Address (if different) _________________________________ City or Town, Zip Code

Gender: Male

Female

_______________________________________
In order to meet federal requirements for audio ballots and to accommodate individuals with disabilities, please print your name phonetically on the line above. (i.e. Peggy Nighswonger would be Peg-gee Nice-wong-ger)

_________________________________ Telephone Number _________________________________ E-mail Address & Website Address

Filing Dates Filing Office Filing Fee

... ... ...

August 4 through August 23, 2010 County Clerk None

This form can be accessed on the Secretary of State's WEBSITE at:

http://soswy.state.wy.us/Forms/FormsFiling.aspx

Qualifications for Office
* Are you holding an office which may conflict, or be incompatible, with the office for which you are filing? Or, is your employment incompatible with the office you are seeking? Qualified elector residing in the community college district and in the subdistrict, if the district is divided into subdistricts. (W.S. 22-22-201(b))
For office use only: Candidate Packet _______

*

3/2009 appnomcc