KEA Delegate Nomination Form

Directions for Nomination Form: Completely fill in all required information on form.
Click in each text box to the right of the information. Fill out completely.
Email Nomination Form to jennifer.lawson@jcta.org before 5pm on Wednesday January 18, 2017.
Jefferson County Teachers Association, 1941 Bishop Lane, Suite 300, Louisville, KY 40218
(502) 454-3400, www.jcta.org

2017 KEA Delegate Nomination Form Fill in information completely.
Name:
School/Location:
Last 4 digits of Soc. Sec. Num:
Phone Number:
Home Address:
Home Email Address:
Nominated by:

Optional Resume: (50 words maximum only) TIP: To Count your Resume words, Use Word Count in the Review tab after you have highlighted your selection of words below.

KEA Delegate Nomination Form	Wed 1/20/2016 4:05 PM