Fillable Affidavit of Qualifications for Wisconsin Technical College District (Nicolet Area Technical College)

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Affidavit of Qualifications for Wisconsin Technical College District (Nicolet Area Technical College)

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Revised April 2020 Page 1 of 5
Affidavit of Qualifications for
Wisconsin Technical College District Board Membership
Wisconsin Statutes establish requirements for the process of selecting members who will serve
on the district boards of the 16 local colleges that make up the Wisconsin Technical College
System. Applicants must submit this affidavit if applying for any of the 16 WTCS Boards, except
Milwaukee Area Technical College (MATC).
Do not use this affidavit if you are seeking to serve on the MATC Board. Those applying to serve
on the MATC Board must apply using the specific MATC affidavit form available at Documents
for District Board Applicants.
To become a candidate who is considered to serve on the board of a Wisconsin Technical
College you must:
1. Submit a properly completed, signed and notarized affidavit of your qualifications to
the district board appointment committee by the deadline established in the published
announcement requesting applications;
2. Attend a district board appointment committee public hearing in person and be
interviewed; and
3. Submit at least two letters of reference supporting your candidacy.
If approved to serve on a district board, you are required to abide by the State of Wisconsin
Code of Ethics and must file annual financial disclosure statements with the State of Wisconsin
Ethics Commission.
Board members serve without salary or per diem. Actual and necessary expenses incurred in
the performance of their duties are reimbursed.
Each year, three members are appointed to serve a three-year term that begins on July 1.
According to Wisconsin Statutes, each of the 15 boards (excluding MATC) must include the
following nine members:
• 3 additional members;
• 2 employers;
• 2 employees;
• 1 school district administrator; and
• 1 elected official.
Revised April 2020 Page 2 of 5
Identification and Residency
Eligible candidates must reside in the technical college district for which they seeking to be
appointed as a board member.
I, , reside at
(Name of Candidate – please type or print)
(Street) (City, Village, Town) (Zip Code)
(County) (Area Code / Phone Number)
I am a resident of the Technical College District and
(WTCS College Name)
I meet the requirements for serving on a district board as outlined in s. 38.08, Wis.
Stats.
Minority Status: You will be considered a minority if you indicate any of the following
categories:
American Indian or Alaskan Native
Black/African American
Asian
Native Hawaiian and Other Pacific Islander
Hispanic
Two or More Races
Gender:
Male
Female
Board Membership Category
Please identify all board membership categories for which you may qualify; many people qualify
for membership in more than one category. For instance, you automatically qualify as an
additional member for the college where you live. If you are working, you might also qualify as
an employer or employee member.
Do not use this form if you are applying for membership on the Milwaukee Area Technical
College District Board. Instead, applicants for the MATC Board must use the specific MATC
affidavit form.
Revised April 2020 Page 3 of 5
Check all that apply:
Additional: All residents of a technical college district are eligible to serve as an additional
member for that college.
Employer: To qualify as an employer, you must receive earnings as payment for your
service and possess the power to hire, transfer, suspend, layoff, recall, promote,
discharge, assign, reward or discipline other employees or adjust employee grievances or
effectively recommend such action if in connection with the exercise of such power the
person exercises independent judgment in relation to the power.
Employer does not include a person acting in the capacity of officer or agent of a labor
organization. At the time of their appointment, employers also must be actively engaged
in business and employ others.
Check all of the actions that are part of your regular responsibilities as an employer:
Assign
Discharge
Hire
Promote
Reward
Transfer
Adjust Grievances
Discipline
Layoff
Recall
Suspend
Employer and Your Position:
(Company/Organization/Name/Title)
(Street)
(City/State/Zip Code/Business Phone Number)
Date appointed to current position:
Employee: You receive payment for work performed but do not qualify as an employer
using the definition described above. An officer or agent of a labor organization
automatically qualifies as an employee.
Employer Name
Title/Position
Revised April 2020 Page 4 of 5
School District Administrator: You are considered an applicant in the school district
administrator category if, as defined in s. 115.001(8), Wis. Stats., you are a school district
superintendent, supervising principal, or other person who acts as the administrative
head of a school district.
Elected Official: You are considered an applicant in the elected official category if, as
defined in s. 5.02, Wis. Stats., you are a state or local elected official.
City Council
Common Council
County Board
School Board
Other
State Legislature
Town Board
Town Clerk
Village Board Sheriff
(specify)
Additional Information
With your affidavit, please submit up to a one-page single-spaced statement describing your
reasons for seeking an appointment to the board of your local college.
If you are applying as an employer or employee member and your job is located outside the
geographic boundaries of the district in which you reside, your statement should include how
your company serves the population of the technical college district for which you are seeking
to serve on the board.
You also may attach a resume or additional sheets to describe your:
• Employment or work history;
• Membership and positions held in business, professional, or civic groups and labor
organizations;
• Educational background and degrees conferred;
• Honors, awards, or citations; and
• Any other information you believe would be helpful for the appointment committee.
Revised April 2020 Page 5 of 5
Your affidavit is not complete unless it is signed and notarized:
I declare the information I have included in this affidavit is accurate to the best of my
knowledge and is submitted pursuant to Chapter 38.08 and 38.10, Wis. Stats., and
Chapter TCS 2, Wis. Adm. Code. I agree that I will provide any additional requested
information or respond to questions from the local district board appointment
committee or the Wisconsin Technical College System Board as needed to verify my
qualifications for the board member position I am seeking.
Candidate Signature
Candidate email address:
Notarized per s. 706.07(8), Wis. Stats.:
State of
County of
Signed or att
ested before me on
by .
(Date) (Name of Applicant)
Signature of Notarial Officer (Seal, if any)
My commission expires .
My commission is permanent.
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Affidavit of Qualifications for Wisconsin Technical College District (Nicolet Area Technical College)

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Completed 4 February 2021

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