Members

NEA Statewide Delegate Nomination Form

2023 NEA Delegate Nomination Online Form

2023 NEA Delegate Nomination Form

Nomination for election to serve as a Kentucky delegate to the NEA Representative Assembly,
July 2 to July 6, 2022 in Orlando, Florida.

You may submit a photo to be posted with your biographical information; photos submitted electronically
should be in “jpeg” format and must be submitted with this form.

This completed form must be received in the KEA office by 5:00 pm (Eastern Time) on Tuesday, January 17, 2023 in order for you to be listed on the official ballot.

Late received forms will not be accepted.

Full Name

Street Address

City, State, Zip

Email Address (optional; non-work /personal e-mail address preferred)

Preferred Telephone Number

Race / Ethnicity (Optional)

KEA / NEA Member Number (on KEA membership card or on KEA app)

Local Association

Employment Position (required)

Biographical Information (25 word limit)

The location of the school where you work determines the electoral region in which you are nominated. See below this form for more information. Please select the region in which you work:

Are you an administrator? (KEA may be allowed administrator delegate(s); however, that is determined by administrator membership on January 21, 2023.
Administrators may be nominated, but will only be able to serve if administrator delegate positions are available.)

Photos to be posted on the website must be submitted with this form. Are you including a photo for use on the ballot?

If yes, submit your photo here. (jpeg/jpg format only)

By checking this box, I UNDERSTAND THERE IS A 25 WORD LIMIT TO THE BIOGRAPHICAL INFORMATION I PROVIDE, AND THAT KEA RESERVES THE RIGHT TO EDIT SUBMISSIONS, If elected, I promise to attend all business sessions and state caucus meetings during the NEA Representative Assembly and to follow other guidelines established by the KEA Board of Directors.
I agree
Signature of Nominee (type name)

Date