2022 School Council Nomination

School Council Nomination

Self-nomination form for parent, school employee or community member
Please indicate which category you would like to nominate for:
Name

First NameLast Name
Email
example@example.com
Phone:
Residential Address (not PO box)

Street Address

Street Address Line 2

CityState

Post Code
I am the parent / guardian of (student/s below) who is/are currently enrolled at Mount Beauty Primary School
Student Name
I am an employee of the Department of Education & Training
I am an employee of the School Council
I am engaged in work at and for the school
I am prepared to serve as a parent member of Mount Beauty Primary School Council.

I hereby declare that:
- I am not and have never been insolvent under administration.
- I am of sound mind.
- I have not been found guilt of an offence that is, or would in Victoria be, an indictable offence.
- I am not a registrable offender within the meaning of the Sex Offenders Act 2004.
- I am not suffering from any medical condition that would affect my ability to perform the role of member of school council.
Signature of candidate
Date

DayMonthYear
Date
Please verify that you are human
Should be Empty: