WE ENCOURAGE CANDIDATES TO UTILIZE THE ONLINE FORM (or this paper form may be submitted).
A candidate must file a nomination form with the Executive Director-Treasurer by 5 p.m. on Friday, January 13, 2017, regardless of postmark.
NAME OF CANDIDATE: ____________________________________________________________
MEMBER ID #: __________________________________________________________________
HOME ADDRESS: ________________________________________________________________
SCHOOL ADDRESS: ______________________________________________________________
WORK PHONE: __________________________________________________________________
LOCAL ASSOCIATION (leave blank if retired):__________________________________________
PLEASE CHECK THE BOX TO INDICATE THE ELECTED POSITION YOU ARE SEEKING
CANDIDATE MUST FILL OUT A SEPARATE NOMINATION FORM
FOR EACH POSITION SOUGHT. Please check one box only.
q Retired Delegate to MTA Annual Meeting
q Regional Ethnic Minority Delegate to MTA Annual Meeting*
q Regional Delegate to NEA RA
q Statewide, Non-Supervisor Delegate to NEA RA
q Statewide, Supervisor Delegate to NEA RA
q Retired Delegate to NEA RA
q Teacher or Education Support Professional
q Administrator or Supervisor
q Retired Member
*Candidates for Regional Ethnic Minority Delegate to Annual Meeting,
please indicate your ethnic minority designation:
q Black or African American
q American Indian or Alaska Native
1. MTA Policy: Each candidate may submit by the deadline 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. A date represented as “October 1, 2016” shall constitute three words. The same date
represented as “10/1/16” is only one word.
10. Send this entire nomination form and photo to: MTA Governance and Administration Division,
2 Heritage Drive, 8th Floor, Quincy, MA 02171-2119. Only submissions received by January 13,
2017, will be published with the ballot. A photo the MTA has used within 2 years may be reused.
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 I have e-mailed a photo to email@example.com
(high-resolution JPEG – 300 dpi).
q Photo enclosed.
q Use my 2015 or 2016 photo.**
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:_______________________________________________
q Native Hawaiian or Pacific Islander
q Cape Verdean
**MTA can only use past photos if published for 2015 or 2016 elections