WACSSO State Councillor Nomination Form

WACSSO State Council Nomination Form

Please complete the following to nominate for the position of State Councillor for WACSSO.
The Nomination period is now open for the following WACSSO By-Elections:
- Goldfields-Esperance Electorate (nomination period closes noon, Friday 8 November 2024)
- South West Electorate (nomination period closes noon, Friday 8 November 2024)
- Peel North Electorate (nomination period closes noon, Friday 13 December 2024)
On submission of this form, you will receive a PDF of the information by email. The PDF needs to be signed by two P&C Office Bearers (not the applicant).

The nomination will only be considered complete once WACSSO has received the following documentation:
- The signed PDF
- Either an Education Department Screening Clearance no older than six months or evidence of submitting a clearance application and any other documentation complying with any other Department of Education requirements (WACSSO Constitution Rule 13.8.6) Apply online only at www.education.wa.edu.au/ncchc
- A copy of your P&C Meeting Minutes containing the nomination resolution
- A copy of your P&C Membership receipt
Please email the above to the Corporate Support Officer via corporatesupport@wacsso.wa.edu.au

PRIVACY DECLARATION

WACSSO is committed to protecting the privacy and security of personal information collected about individuals. Personal information means information about an individual whose identity is apparent or can reasonably be ascertained from the information. The information will be stored either in the manner in which it has been provided to WACSSO or on our internal computer network system. WACSSO takes all reasonable steps to protect personal information from misuse and loss, unauthorised access, modification or disclosure. Personal information provided on this form is not circulated to external organisations unless authorised by the nominee.
Title (Mr/Mrs/Ms/Miss)*
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Which P&C are you a financial member of?*
Type of Association*
Electorate*
Do you declare that you have not been disqualified from managing a corporation under the Corporations Act 2001 (Cth), nor disqualified from being a Responsible Person of a registered charity by the ACNC Commissioner? If elected, do you agree to abide by the WACSSO Constitution including the State Councillor responsibilities?*

YesNo
P&C Membership History - Year/Name of P&C Association (information to be sent out to all affiliated P&Cs in the electorate if a ballot is conducted)*
P&C Office Bearer History - Year/Position held/Name of P&C Association (information to be sent out to all affiliated P&Cs in the electorate if a ballot is conducted)*
Other relevant community involvement - Year/Position held/Community Group (information to be sent out to all affiliated P&Cs in the electorate if a ballot is conducted)*
Brief Statement of Nominee's Aims and Achievements (information to be sent out to all affiliated P&Cs in the electorate if a ballot is conducted)*
A nomination for State Councillor requires a resolution passed at a duly convened P&C Meeting and the signatures of two P&C Office Bearers (not the applicant). Please provide the details of the two P&C Office Bearers who will confirm the endorsement.
Office Bearer 1: Name*
First Name and Surname
Office Bearer 1: Position*
Officer Bearer 2: Name*
First Name and Surname
Office Bearer 2: Position*
Submitted Date (read only field)

DayMonthYear
Date
Time Submitted

Hour Minutes
Affiliate Name:
Should be Empty:

WACSSO State Council Nomination Form