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Declaration of Candidacy for CTA/NEA-Retired State Council Representative and Minority At-Large Director DEADLINE TO RETURN DECLARATION IS JAN. 31, 2011 Offices to be filled: CTA/NEA-Retired representative to CTA State Council for District 4 Term: 1 year, beginning June 26 (filling a vacancy) Requirements: A candidate must be a member of CTA/NEA-Retired and reside in the electoral district she/he is elected to represent. CTA/NEA-Retired Minority At-Large Director Term: 3 years, beginning June 26 Requirements: A candidate must be a member of CTA/NEA-Retired and be a member of one of the four recognized CTA ethnic minority groupings. I am a candidate for the office of: State Council Representative: Minority At-Large Director I am: African American Asian/Pacific Islander My contact information: (Please print) ____________________________________________________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ ( Name Home Address City & Zip Home phone ____________________________________________ E-mail Address My campaign statement: As a candidate for CTA/NEA-Retired State Council representa- tive or Minority At-Large Director, you may write a candidate statement of no more than 35 words, which will be included with the ballot. If more words are used, the statement will include only the first 35. Reference to ethnic minority identification will not be counted in the 35-word limitation. __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________ Date _____________________________________________________________ Signature THIS FORM MUST BE RECEIVED NO LATER THAN 5 P.M. JAN. 31, 2011 Mail to CTA/NEA-Retired Elections, Attn: Human Rights/Community Outreach, P.O. Box 4156, Burlingame, CA 94011-4156. Candidates may wish to return this form by certified mail in order to get a receipt and ensure compliance with the deadline. Mailing Address City & Zip ) ____________________________________ ( ) _____________________________________ Cell phone District 4 County of residence: ____________________________ American Indian/Alaska Native Hispanic CTA/NEA-Retired to elect State Council rep and At-Large Director Jan. 31 is the deadline to sub- mit nominations for CTA/NEA-Re- tired State Council representative for District 4 and Minority At- Large Director. Anyone wishing to run for a position should complete the Declaration of Candidacy form (left) and return it to the address on the form. Terms, which begin June 26, are three years for Minority At-Large Director and one year for District 4 representative to fill a vacancy. The ballot, including names of the candidates and their campaign statements, will be mailed to mem- bers in February. For more informa- tion, call (650) 552-5468. Electoral districts Following are the electoral districts for CTA/NEA-Retired. RETIRED DISTRICT 1 Alameda Contra Costa Del Norte Humboldt Lake Marin Mendocino Monterey Alpine Amador Butte Calaveras Colusa El Dorado Fresno Glenn Kern Kings Lassen Madera Mariposa Merced Modoc Nevada Los Angeles San Luis Obispo Imperial Inyo Mono Orange Napa San Benito San Francisco San Mateo Santa Clara Santa Cruz Solano Sonoma RETIRED DISTRICT 2 Placer Plumas Sacramento San Joaquin Shasta Sierra Siskiyou Stanis laus Sutter Tehama Trinity Tulare Tuolumne Yolo Yuba RETIRED DISTRICT 3 Santa Barbara Ventura RETIRED DISTRICT 4 Riverside San Bernardino San Diego DECEMBER 2010 • JANUARY 2011 | 35

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