Fillable DELEGATE - 4 (Association of California School Administrators)

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DELEGATE - 4 (Association of California School Administrators)

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20/2 DELEGATES
(PDLO or mail to: /RUL$OOUHG
ACSA- E-Mail ODOOUHG@acsa.org
1029 J Street, Suite 500
Sacramento, CA 95814
20/2 DELEGATES REGION _______
(If your region has more than three – other than the President, President Elect and VP for
Legislative Action)
DELEGATE - 4
Name: Social Security #:
Title: District:
School:
Address:
City/State/Zip:
Home Address:
Work phone: Work Fax Number:
Home phone: E-mail Address
Please check the appropriate box for affirmative action: Male Female
African/American Asian Caucasian
Eskimo-American Pacific-Islander Latino
Filipino
20/2 DELEGATES
Email or mail to: Lori Allred
ACSA- E-Mail lallred@acsa.org
1029 J Street, Suite 500
Sacramento, CA 95814
20/2 DELEGATES REGION _______
(If your region has more than three – other than the President, President Elect and VP for
Legislative Action)
DELEGATE - 5
Name: Social Security #:
Title: District:
School:
Address:
City/State/Zip:
Home Address:
Work phone: Work Fax Number:
Home phone: E-mail Address
Please check the appropriate box for affirmative action: Male Female
African/American Asian Caucasian
Eskimo-American Pacific-Islander Latino
Filipino
2020/21 DELEGATES
Email or mail to: Lori Allred
ACSA- E-Mail lallred@acsa.org
1029 J Street, Suite 500
Sacramento, CA 95814
2020/21 DELEGATES REGION _______
(If your region has more than three – other than the President, President Elect and VP for
Legislative Action)
DELEGATE - 6
Name: Social Security #:
Title: District:
School:
Address:
City/State/Zip:
Home Address:
Work phone: Work Fax Number:
Home phone: E-mail Address
Please check the appropriate box for affirmative action: Male Female
African/American Asian Caucasian
Eskimo-American Pacific-Islander Latino
Filipino
2020/21 DELEGATES
Email or mail to: Lori Allred
ACSA- E-Mail lallred@acsa.org
1029 J Street, Suite 500
Sacramento, CA 95814
2020/21 DELEGATES REGION _______
(If your region has more than three – other than the President, President Elect and VP for
Legislative Action)
DELEGATE - 7
Name: Social Security #:
Title: District:
School:
Address:
City/State/Zip:
Home Address:
Work phone: Work Fax Number:
Home phone: E-mail Address
Please check the appropriate box for affirmative action: Male Female
African/American Asian Caucasian
Eskimo-American Pacific-Islander Latino
Filipino
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DELEGATE - 4 (Association of California School Administrators)

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Completed 29 July 2020

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