Appendix D

Montgomery County Region of the Maryland Association of Student Councils

Student Member of the Board of Education

Montgomery County, Maryland
2010 Nomination Form
Qualifications for office: The student member shall be a bonafide resident of Montgomery
County and a regularly enrolled junior or senior year student from a Montgomery County public
high school.* (Section 3-701, Education Article Annotated Code of Maryland)

*Explanation: The student must be in his/her sophomore or junior year at the time of nomination.

Who may nominate: Any student enrolled in middle school through Grade 12 in a Montgomery
County public school may nominate a student member candidate.
( ) Check here if this is a self-nomination. Nominee’s current grade in school:
Name of Nominee School of Nominee
Address of Nominee
Street

City Zip
Home Telephone Number of Nominee
Cell Phone Number of Nominee
Email Address of Nominee

Signature of Nominee Date Signature of Nominator Date

To Be Completed by Administrator
The above named individual, , has been nominated for
the student seat on the Montgomery County Board of Education. I affirm that said
individual is a student at High School and that he/she will
be a junior or senior during the 2010–2011 school year.
Signature of Administrator Date

Filing Deadline: This form must be in the possession of the MCR/Student Affairs Office (Room
120, Lakelands Park Middle School, 1200 Main Street, Gaithersburg, MD 20878) no later than
4:00 p.m., Friday, January 22, 2010. (fax 301-670-1407) (If faxed, the original should be
received by 4:00 p.m., January 28, 2009.) Candidates should confirm the receipt of his/her
application by calling the Student Affairs Office at 301-670-1419.

Election of the Student Member of the Board of Education––Protocols 2009-2010 page 27