8/7/2019 2011 Application for FCDC Endorsement - School Board, District (as Approved)

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APPLICATION FOR ENDORSEMENT BY THE

FAIRFAX COUNTY DEMOCRATIC COMMITTEEFor

 _______ District School Board Member – General Election – November 2011

Any individual who is running for this non-partisan elected office (Fairfax County School Board) may request endorsement of 

his or her candidacy by the Fairfax County Democratic Committee (FCDC). Any candidate seeking the endorsement of FCDC

must complete this Application and the attached Questionnaire and submit both along with a non-refundable $200 Filing Fee 

to the FCDC District Chair in the applicable district or a designee by 5:00 PM on April 28, 2011. The designated address is

 ______________________________________________________________________________________________________ 

 _____________________________________________________________________________________________________.

The candidate understands that he or she may be interviewed in person by the District Committee and may be requested to

 provide additional information. The candidate further understands and agrees that completion and submission of the

application and questionnaire does not guarantee that any endorsement shall be provided and that endorsement is granted at the

sole discretion of FCDC.

The candidate who receives the endorsement of FCDC is eligible to receive the following benefits:

• Authorization to include “Endorsed by the Fairfax County Democratic Committee” on campaign materials.

• Promotion of campaign events through use of the FCDC Calendar.

• Link to the campaign website published on the FCDC website.

• Space for phone banking (as available).

• Use of FCDC Auto dialer (as available).

• Eligibility to receive campaign contributions from FCDC.• Inclusion on the Democratic Sample Ballot on Election Day

• Authorization to establish a VAN Account.

One of the primary functions of the Fairfax County Democratic Committee and the Magisterial District Committees is the

support and election of Democratic candidates to all levels of public office. Therefore, any candidate who does not receive the

endorsement of FCDC WILL NOT be eligible for the above benefits. No FCDC or Magisterial District resources will be used

in the support or promotion of any unendorsed candidate.

 NAME: ___________________________________________________________________________________ 

ADDRESS: ___________________________________________________________________________________ 

 ___________________________________________________________________________________ 

PHONE: _________________________ EMAIL: _______________________________________________ 

OCCUPATION: _____________________________________EMPLOYER:______________________________________ 

OFFICE SOUGHT: _________________ District School Board Member – General Election – November 2011

I certify that I am a Democrat and pledge to support any Democratic nominee or candidate endorsed by the Fairfax County

Democratic Committee in the 2011 General Election. I understand that any action contrary to this pledge may result in a repeal

of the Democratic endorsement.

I hereby request the endorsement of my candidacy by the Fairfax County Democratic Committee. I fully understand that

submission of this application and questionnaire does not constitute endorsement or promise of endorsement by FCDC. Icertify that I have answered the questions truthfully to the best of my knowledge and authorize FCDC or their agents to verify

the information herein contained.

CANDIDATE: FCDC ACKNOWLEDGEMENT OF RECEIPT:

 ______________________________ ______________________________  

Signature Date Signature DateFiling check should be payable to FCDC.

Inquiries should be directed to:

Antonia Scatton, FCDC Executive Director – 703 573-6811

Barbara Caputo, FCDC Task Force on School Board Endorsement – 703 476-4229