Application for Certification Only

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(name as it will appear on the ballot)
MM slash DD slash YYYY
Is the position partisan or non-partisan?*
Are you an incumbent for the position sought?*
If so, when? For what position?
If so, when? By which party? For what position?
If so, when? By which party? For what reason?
If so, please explain your background in Democratic Party issues and politics, such as: length of membership in a Democratic Party, acting as a Precinct Committee Officer; involvement in/support of Democratic issues as set forth in the party platform, participation in Democratic committee work or special events, past donations to Democratic candidates, and/or work with non-profit organizations whose work closely parallels Democratic Party values. If not, do you identify with another party? If so, which party?
If so, please explain which party, during what period of time, and why you have switched party affiliation.

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