EvergreenHealth Monroe Commissioner Public Nomination Form Fall 2024

Commissioner Public Nomination Form
Today's Date*

MonthDayYear
Nominator's Information
Nominator's First Name*
Nominator's Middle Name*
Nominator's Last Name*
Nominator's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Nominator's Email Address*
example@example.com
Nominator's Phone Number*
Please enter a valid phone number.
Are you a registered voter in Snohomish County?*

YesNo
Nominator must be a registered Snohomish County voter.
Do you live within the Snohomish County Public Hospital District #1 boundaries?***

YesNo
**Nominator must live within the Snohomish County Public Hospital District #1 boundaries. To verify that you reside in Snohomish County Public Hospital District #1 boundaries please click here. Select "Hospital" at the top, enter your address or intersection in the search bar hit enter, your 'marker' should reside within the yellow map of Hospital District 1.

Commissioner Public Nomination Form