CeSPNC Candidate Application Form

Prior to submitting this application, candidates are encourage to visit this page and view the Board Member Expectations.
Candidate Filing Application

To apply as a candidate for the vacant seat, please complete all questions. The board will appoint a candidate for the seat at the Regular Meeting on Tuesday, October 9, 2018. (Please visit the website for location and agenda. The meeting is called to order at 6:00pm. www.centralsanpedro.org.) All applications must be received by 5:00pm, Monday, October 8, 2018 and candidates must attend the meeting in order to be appointed. Candidates must provide documentation and any other applicable identification to establish their stakeholder status. For more information regarding this form and acceptable forms of documentation, call 310-918-8650.
Full Name *

First Name Middle Name Last Name

Current Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Email Address *
Phone Number *

- Area Code Phone Number
Name as it should appear on the ballot. *
You must be at least 18 years of age and a stakeholder within the Central San Pedro Neighborhood Council boundaries to qualify as a candidate. Stakeholders are defined as anyone who lives, works or owns real property within the neighborhood and also those who declare a stake in the neighborhood as a community interest stakeholder, defined as a person who affirms a substantial and ongoing participation within the neighborhood council's boundaries and who may be in a community organization such as, but not limited to, educational, non-profit and/or religious organizations. [Definition text mandated by Los Angeles Administrative Code SS22.811(a)(2)]
Stakeholder Status (Choose one from the list below) *

I am a resident within the neighborhood council boundaries at the address below. I own a business or work within the neighborhood council boundaries at the address below. I own property within the neighborhood council boundaries at the address below. I have a vested interest in this neighborhood council based on the following.
Enter the address and/or name of the organization/place of employment which qualifies you as a Stakeholder. *
Candidate Statement (tell us why you would like to run for a board seat). (100 words or less) *
Upload a photo to be included with your candidate statement *
Two forms of documentation confirming stakeholder status are required per the CeSPNC bylaws. Upload Document #1 to prove your eligibility as a stakeholder (example: driver's license, passport, etc.) *

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Upload Document #2 to prove your eligibility as a stakeholder (example: utility bill, letter from organization, etc.)

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I attest that I meet the qualifications of a stakeholder, that I am at least 18 years of age, and that all of the above statements are true and correct.
Electronic Signature (Type your name here) *
Signature date: *

- Month - Day Year
Date
Should be Empty:

Candidate Filing Application