Delegate Candidate Information Form March 15, 2021 By Matthew Banks All delegate candidates should fill out the following form. Submissions are due April 11th. Please contact email@example.com if you have questions about this form. Nomination Verification Form Please complete one form per nominee. Name* First Last Name as it should be listed on the ballot (includes full name and/or nickname)Phone Number Working Title Department Email Campus Box NumberYears of University Service Years of State Service Supervisor's Name First Last Supervisor's Phone Number Supervisor's Campus Box NumberSupervisor's Department Supervisor Agree with Candidate's Service? Yes No Chair or Department Head Chair or Department Head Campus Box NumberPlease submit 100 word biographical sketch (optional but suggested)Other comments or questions?CommentsThis field is for validation purposes and should be left unchanged. Save and Continue Later Δ Comments are closed.