Fillable STATE COMMITTEE CHAIR RECOMMENDATION FORM (Association of California School Administrators)

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STATE COMMITTEE CHAIR RECOMMENDATION FORM (Association of California School Administrators)

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STATE COMMITTEE CHAIR
RECOMMENDATION FORM
COMMITTEE NAME:
NOMINEE #1
Name Region
Title District School
Address
(Street) (City) (State) (Zip)
Telephone Fax E-mail
* Please be sure to check the appropriate box for affirmative action: Male Female
African/American Asian Caucasian
Eskimo – American Indian Filipino Latino Pacific Islander
COMMENTS:
NOMINEE #2
Name Region
Title District School
Address
(Street) (City) (State) (Zip)
Telephone Fax E-mail
* Please be sure to check the appropriate box for affirmative action: Male Female
African/American Asian Caucasian
Eskimo – American Indian Filipino Latino Pacific Islander
COMMENTS:
SUBMITTED BY:
Please return completed forms to: Adelita Dizdarevic, Governance Assistant
ACSA, 1029 J Street, Suite 500, Sacramento, CA 95814
STATE COMMITTEE CHAIR
RECOMMENDATION FORM
COMMITTEE NAME:
NOMINEE #3
Name Region
Title District School
Address
(Street) (City) (State) (Zip)
Telephone Fax E-mail
* Please be sure to check the appropriate box for affirmative action: Male Female
African/American Asian Caucasian
Eskimo – American Indian Filipino Latino Pacific Islander
COMMENTS:
NOMINEE #4
Name Region
Title District School
Address
(Street) (City) (State) (Zip)
Telephone Fax E-mail
* Please be sure to check the appropriate box for affirmative action: Male Female
African/American Asian Caucasian
Eskimo – American Indian Filipino Latino Pacific Islander
COMMENTS:
SUBMITTED BY:
Please return completed forms to: Adelita Dizdarevic, Governance Assistant
ACSA, 1029 J Street, Suite 500, Sacramento, CA 95814
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STATE COMMITTEE CHAIR RECOMMENDATION FORM (Association of California School Administrators)

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Completed 29 July 2020

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