REQUEST FOR COMMITTEEAPPOINTMENT

Dear President Lewis:I would like to be appointed to the CTU ___________________________Committee. Iunderstand that I am required to attend monthly committee meetings during the schoolcalendar year.

NAME

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SCHOOL

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SCHOOL TELEPHONE

( ______ )_____________________________________________

HOME ADDRESS

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CITY/ZIP

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HOME TELEPHONE

( ______ )_____________________________________________

EMAIL ADDRESS(HOME) www.

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(WORK) www.

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LIST OTHER UNION/COMMITTEES ANDSCHOOL ACTIVITIES______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________UNION INVOLVEMENTDELEGATE /ALTERNATE DELEGATE

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YES

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NOWHY DO YOU WANT TO JOIN THISCOMMITTEE? (USE REVERSE SIDE IFNECESSARY.______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

_____________________________________________________________ ___________________________________APPLICANT’S SIGNATURE DATE_____________________________________________________________ ___________________________________CHAIRPERSON’S APPROVAL DATE_____________________________________________________________ __________________________________LIAISON’S SIGNATURE DATE_____________________________________________________________ ___________________________________PRESIDENT’S APPROVAL DATE

ADDRESS and MAIL COMPLETED FORM TO:STANDING COMMITTEES

c/o

Karen GJ Lewis, NBCT, PresidentChicago Teachers Union222 Merchandise Mart Plaza, Suite 400Chicago, Illinois 60654-1016

OFFICE USE ONLY Date Application Processed_____________________20___Date of ApplicantNotification:___________________20___Initials ________________