2023 CNC Candidate Application Form

ATTENTION: All candidates appearing on the ballot must complete all portions of this application (including documentation, photo and candidate statement) and submit this form by 11:59 p.m., Thursday, February 16, 2023. Any forms received, postmarked, faxed or emailed after that date or time will not be processed. There are no write-in candidates. Candidates must provide documentation and any applicable identification (uploaded on this form, by email or in person) to establish their stakeholder status by this deadline otherwise their filing will not be complete. If using a driver's license as ID, you may mask the driver's license number. Every candidate must provide an acceptable photo ID. For more information regarding this form and acceptable documentation, see the 2023 Selection Manual at ChatsworthCouncil.org, or contact vote@ChatsworthCouncil.org or (818) 564-6819. NOTE: Don't forget to also pre-register as a voter. If your contact information is inaccurate, we may not be able to reach out to you.

Name*

First NameLast Name

E-mail*

Phone Number*

Area CodePhone Number

Birth Year (Must be 18 or older.)*

Type Any No.Type Any No.Year

Mailing Address*

Mailing Address Line 1

Mailing Address Line 2

CityState / Province

Postal / Zip CodeCountry

Name on Ballot*

How do you want your name to appear? No professional designations allowed, eg: PhD, MSW, Esq., Rev., Dr., etc.

Stakeholder Category (Select only ONE category)

I am a stakeholder in the Chatsworth Neighborhood Council because [check only one]:

I own property within the boundaries of the Chatsworth Neighborhood Council at

Must include street address and Zip code. No P.O. Boxes accepted.

I am a resident within the Chatsworth Neighborhood Council boundaries at

Must include street address and Zip code. No P.O. Boxes accepted

I own a business or work within the boundaries of the Chatsworth Neighborhood Council at

List the name of the business or place of work.

List the street address of the business or place of work, including Zip code. No P.O. Boxes are accepted.

I board one or more horses within the boundaries of the Chatsworth Neighborhood Council at

Must include stable name, property street address and Zip code. No P.O. Boxes accepted.

I am a community interest stakeholder, defined as a person who affirms a substantial and ongoing participation within the Neighborhood Council’s boundaries prior to Jan. 1, 2023, and who may be in a community organization such as, but not limited to, educational, non-profit and/or religious organizations.

Must name the organization.

List street address and Zip code within the boundaries of the Chatsworth Neighborhood Council. No P.O. Boxes accepted.

Upload Your Documentation.*

Upload a File

See ChatsworthCouncil.org for list of documentation types. Most common is your Driver's License. Questions? Call (818) 564-6819.

Upload a Headshot Photo or Selfie.*

Upload a File

Photo should be suitable for printing on the CNC website.

Maximum 250-Word Biographical Essay or Campaign Statement.*

Type or paste text in the box.0/250

By dating and submitting this form, I declare under penalty of perjury that the above statements are true and correct.

Today's Date*

MonthDayYear