2017 School Governance Council Parent/Guardian Candidate Declaration Form

Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail*

Phone Number*

Area CodePhone Number

Section II - SCHOOL, STUDENT, & TERM INFORMATION

List the school in which you are interested in running for an SGC position (you must have a child that will be enrolled at this school during the 2017-18 and 2018-19 school years)*

I am the parent/legal guardian of this student (provide the name of the student[s] who attends the above referenced school):*

In order to serve on the School Governance Council in a "Parent" position, you may not be an employee of the school or be an elected official.

I am an employee of the above referenced school*

I am an elected official*

SECTION III - CRIMINAL BACKGROUND PRELIMINARY SCREENING

Each of the following questions must be answered with a "Yes" or "No." If any answer is yes, please povide a brief explanation below.

Have you ever been found guilty, entered a plea of nolo contendere, been granted first offender treatment without adjudication of guilt, been placed under a court whereby an adjudication or sentence was otherwise withheld for a felony or any misdemeanor of a high and aggravated nature, or is any charge currently pending against you of the same nature? (Note: A third DUI conviction raises the offense to a high and aggravated nature.)*

Have you ever been investigated for allegations of sexual offenses?*

Have you ever been accused of and/or investigated for a crime of child abuse or physical abuse?*

If you answered yes to any of the three above questions, please provide a brief explanation here:

Please note, if elected, you will be required to undergo a formal criminal background check by Fulton County Schools Department of Safety and Security. If you have any questions or concerns regarding the criminal background check, please contact the Fulton County Schools Police Department at 470-254-0313.

SECTION IV - CANDIDATE STATEMENT

In 1500 characters or less (spaces included) describe your background, qualifications, and why you wish to serve on the School Governance Council. *

0/1500

SECTION V - SIGNATURE

Serving on a School Governance Council requires a substantial time commitment (4-5 hours per month or more on average). By typing my signature, I attenst that I am fully aware of the requirements of serving, I am the person referenced above, and all other information on this form is true and accurate. I understand that misrepresentation or omission of information will be cause for rejection of my candidacy for a position on the above referenced school's Governance Council.

Signature:*

Date: *

If you are not elected to your school's Governance Council, may the School Governance Council contact you about serving on a committee?*