Declaration of Candidacy FormsDeclaration of Candidacy Form for Interim Valley East NEA Director Deadline for receipt of this form is Friday, November 8, 2024, timestamped by 5:00 pm. Name (required) As you would like it to appear on ballot. Affiliation NEA UTLA Area Valley East Employee ID Number (required) Non-LAUSD Email (required) Street Address (required) City (required) State (required) Zip Code Home Phone Number Cell Phone Number (required) School Phone Number School/Site (required) Permission is granted for UTLA to give contact information to members and media when requested School SiteHome PhoneCell PhoneNon-LAUSD emailCheck those methods that are acceptable to give out. Permission is given for the Elections Committee to verify my membership and to determine that I meet the requirements to be a candidate for the office for which I have declared I agree I declare the above assignment information true to the best of my knowledge. (required) Checking this box represents your e-signature I, __________, candidate for the office of NEA Valley East Director, do hereby declare that I will use the UTLA constituency chapter chair contact information for the sole purpose of contacting members to solicit their votes in connection with the election. I will only disclose this information to members who are participating in my campaign. I will assure that anyone working to assist me in my campaign is aware that this information must only be used in connection with the election. __________ Signature of Candidate __________ Date Signed This form goes to Princess Sykes of the UTLA Elections Committee, who can also be reached at psykes@utla.net or 3303 Wilshire Blvd., 10th floor, Los Angeles, CA 90010 or 1–213–368–6220. Δ