Declaration of Candidacy for Membership on the Regional Committee for School District Organization of Northwest Educational Service District 189

DECLARATION

Name

Director District No.

I do solemnly swear (or affirm) that:

Residence*

I reside within the boundary of Northwest Educational Service District 189 (NWESD 189), within the boundary of Regional Committee Member District No. listed above and am a registered voter of the same Regional Committee Member District.*

Concurrently Serve*

I am aware that, if appointed, I cannot concurrently serve as the Superintendent of Public Instruction, a member of the State Board of Education, an educational service district superintendent, a member of a board of directors of a school district, a member of a governing board of a private school or a private school district which conducts any grades kindergarten through twelve, an officer appointed by any such governing board, an employee of a school district, an employee of an educational service district, an employee of the Office of the Superintendent of Public Instruction or the State Board of Education, an employee of a private school, or an employee of a private school district.*

Candidate Declaration*

I hereby declare myself a candidate for membership on the Northwest Educational Service District 189 Regional Committee on School District Organization for a term of four (4) years beginning on the second Monday of January 2021 subject to appointment by the NWESD 189 Board of Directors.*

Support Constitution*

I solemnly swear (or affirm) that I will support the Constitution and laws of the State of Washington.*

Signature

Address*

Street Address City State / Province / Region ZIP / Postal Code

Date

Title

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