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:*

Parent MemberCommunity MemberSchool Employee
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*

YesNo
I am an employee of the School Council*

YesNo
I am engaged in work at and for the school*

YesNo
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*

Clear
Date*

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