State Public Charter School Authority
Board Member Application

Apply by Tuesday, May 28, 2024

First Name:

Middle Name:

Last Name:

Are you know, or prefer, any other aliases?

What is your date of birth?

mm/dd/yyyy

Ethnicity:

Are you a U.S. Citizen?

Are you a naturalized U.S citizen?

If yes, what is the date of your naturalization?

mm/dd/yyyy

If yes, what is your place of birth?

Are you a veteran?

Are you registered to vote?

Are you a registered lobbyist?

What is your mailing address?

Email:

Primary phone:

Alternative phone:

County of residence:

Resident since:

Who is your curent employer?

Employer address:

Job Title:

Any specialized licensing? If so, please list here

What is your highest completed education level:

If appointed, would this position cause a conflict

What personal and leadership qualities/experiences

If yes, please list all state offices served in:

Resume and Personal Statement

Please provide us with your resume and a personal statement regarding why you would like to serve on the SPCSA Board.

Drop your files here

Do you understand your application will be received for the appointment of the State Public Charter School and NOT the State Board of Education?

Send me a copy of my responses