DELEGATES TO THE NEA RA • REGIONAL ETHNIC MINORITY DELEGATES TO THE MTA ANNUAL MEETING
STATEWIDE RETIRED DISTRICT DELEGATES TO THE MTA ANNUAL MEETING
A candidate must file this nomination form or a facsimile with the Executive Director-Treasurer by 5 p.m. on Friday, January 9, 2015, regardless of postmark.
ADDITIONAL FORMS MAY BE REQUESTED OR THIS FORM MAY BE DUPLICATED. FORMS MAY BE FAXED TO MAUREEN NOYES AT 617.742.7046.
NAME OF CANDIDATE: ____________________________________________________________
MEMBER ID #: __________________________________________________________________
E-MAIL: _______________________________________________________________________
HOME ADDRESS: ________________________________________________________________
______________________________________________________________________________
PHONE:________________________________________________________________________
WORK E-MAIL:__________________________________________________________________
SCHOOL ADDRESS: ______________________________________________________________
______________________________________________________________________________
WORK PHONE: __________________________________________________________________
LOCAL ASSOCIATION: ____________________________________________________________
______________________________________________________________________________
DISTRICT/REGION: _______________________________________________________________
PLEASE CHECK THE BOX THAT CORRESPONDS TO THE OFFICE YOU SEEK:
2015 MTA ANNUAL MEETING
REGIONAL ETHNIC MINORITY
DELEGATE TO THE MTA ANNUAL MEETING
ETHNIC MINORITY DESIGNATION:
(CHECK ONE)
q Asian/Pacific Islander
q Cape Verdean
q Latino
q African-American
q American Indian/Alaska Native
EDUCATIONAL POSITION:
q Teacher or Education Support Professional
q Administrator or Supervisor
STATEWIDE RETIRED DISTRICT
DELEGATE TO THE MTA ANNUAL MEETING
CANDIDATE ELIGIBILITY:
(CHECK ONE)
q MTA Retired member
q MTA life member who is retired and who holds
NEA-R or NEA retired life membership
2015 NEA RA
DELEGATE TO THE NEA RA
EDUCATIONAL POSITION:
(CHECK ONE)
q Teacher or Education Support
Professional
q Administrator or Supervisor
q Retired
q Retired Life
(See policy for definitions.)
I HEREBY DECLARE MY CANDIDACY FOR:
(CHECK ONE)
q STATEWIDE – Non-Supervisor
q REGIONAL – Non-Supervisor
q STATEWIDE OTHER
(Administrator or Supervisor)
q RETIRED
INSTRUCTIONS
1. MTA Policy: Each candidate may submit a headshot photograph and biography/statement
containing no more than 50 words. Note: Only the first 50 words will be printed.
The Credentials and Ballot Committee reserves the right to edit all bios.
2. Write out your statement on a separate piece of paper first, and then fill out the grid.
3. Type or print clearly, using both upper- and lower-case letters, as you expect the final
statement to appear.
4. Insert only one word per box.
5. Do not combine words or numbers with hyphens or slashes.
6. “An,” “a” and “the” constitute one word.
7. Abbreviations such as “NEA-RA” and “MTA” count as one word.
8. Insert punctuation in the same box immediately after the word that you want it to follow.
9. Indicate intent to commence a new paragraph by inserting the paragraph symbol (¶) in the
same box immediately preceding the first word in the paragraph.
10. A date represented as “October 1, 2014” shall constitute three words. The same date
represented as “10/1/14” is only one word.
11. Send this entire nomination form and photo to: MTA Governance and Administration Division,
20 Ashburton Place, Boston, MA 02108. Only this form and photos received by January 9, 2015,
will be published with the ballot. PHOTO ON FILE MAY BE USED. The Credentials and Ballot
Committee may request a new or more recent photo.
BIO/STATEMENT GRID – PLEASE PRINT
PLEASE SELECT FROM THE FOLLOWING AND CHECK THE APPROPRIATE BOXES:
q 50-word (maximum) bio/statement grid enclosed.
q I am not submitting a bio/statement grid.
q Photo sent via e-mail (high-resolution JPEG – 300 dpi).
q Photo enclosed.
q Please return photo.
q Use photo on file.
q I am not submitting a photo.
My qualifications are in accordance with those of the designated position for which I am a candidate:
SIGNATURE: ______________________________________________________________________________________________________ DATE:_______________________________________________
