2018 Endorsment Application
Open to pro-choice Democratic women running for New York state and local office in 2018. Submission deadline: Wednesday, September 5, 5pm. Contact mail@eleanorslegacy.com with any questions.
Full Name:
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First Name
Last Name
County of Residence:
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Office You Are Running For:
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Specify: County, City, Town, District #:
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if applicable
Home Address:
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Personal E-mail:
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Campaign Information
Home Phone:
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Area Code
Phone Number
Occupation:
Campaign Information
Campaign Website:
Campaign Email:
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Campaign Phone:
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Area Code
Phone Number
Campaign Committee Name:
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Campaign Committee Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
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Other
Country
What is the PAC Contribution Limit to Your Campaign:
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Election Details
Name of County Chair (or Town Chair if town race):
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First Name
Last Name
E-mail for Town or County Chair:
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Is this an open seat?
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Yes
No
Are you the incumbent?
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Yes
No
Name of Opponent 1:
First Name
Last Name
Line Opponent 1 is running on:
Name of Opponent 2:
First Name
Last Name
Line Opponent 2 is running on:
Name of Opponent 3:
First Name
Last Name
Line Opponent 3 is running on:
Party lines you are running on:
Democratic
Working Families
Independent
Women's Equality
Green
Conservative
Republican
Other
Are you an enrolled Democrat?
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Yes
No
Are/Were you involved in a primary?
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Yes
No
Are/Were you involved in a Caucus?
Yes
No
If applicable: What was the date of the caucus?
Total number of registered voters in your district:
Total number of votes casts in most recent general election for the position you are seeking:
Indicate Total Number of Votes by Line In Most Recent General Election for Position You are Seeking
Democrat:
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Republican:
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Independence:
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Conservative:
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Working Families:
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Other:
Please Specify
Reproductive Rights
**Judicial applicants are not asked to complete this section**
Are you pro-choice?
Yes
No
Do you agree with the central premise of Roe v. Wade and will you vote to preserve it? The central premise of Roe v. Wade is that a woman has a right to terminate a pregnancy before viability and after viability if, in consultation with her doctor, an abortion is necessary to protect her life or health.
Yes
No
Do you support Federal and State funding for abortions of poor women?
Yes
No
Is there anything in your record that is inconsistent with your position? If yes, please explain.
You and Eleanor's Legacy
Have you ever attended an Eleanor's Legacy Campaign School?
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Yes
No
If you have ever attended a Campaign School, what year did you attend?
Please Select
2024
2023
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1928
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1926
1925
1924
Choose Only 1
Have you ever applied for a Campaign Grant before?
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Yes
No
If yes, when was the most recent year you received a Campaign Grant?
Please Select
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
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1930
1929
1928
1927
1926
1925
1924
Choose Only 1
If yes, in what range was the most recent Campaign Grant?
Please Select
$100-$500
$500-$1,000
$1,000-$2,500
$2,500-$5,000
$5,000+
How did you learn about the Campaign Grant Program?
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Town or County Democratic Committee told me about the Campaign Grant Program
Another woman candidate encouraged me to apply
Learned about the Campaign Grants at the Campaign School
From the Eleanor's Legacy website, email newsletter, or other social media
Other
Attach a copy of your campaign budget.
Attach a copy of your resume.
Attach a campaign photo (saved as .jpeg, no smaller than 68KB)
"I attest that the answers given here are accurate and truthful to the best of my knowledge. I also pledge to use my personal influence to provide support to other pro-choice Democratic women candidates for state and local office in the future, as opportunities my arise."
Please type your name in the space below. A typed name will be accepted as a form of electronic signature.
Date:
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Month
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