Personal Information:
Last Name:
First Name:
Town/Village and State:
Street Address:
[Contact information will be removed before it is distributed for review.]
email Address:
Phone Number:
Candidate Information:
Office Sought
Current Status
Polictical Affiliation:
Name of Your Town Democratic Chairperson:
Town Chairperson's Phone Number:
Do you have the support of your local Democratic Committee?:
Not at this time:
High School/GED:
UnderGraduate/AA School/Degree:
Graduate School/Degree:
Work Background Summary:
Public service/Volunteer Activities:
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What are the top 3 issues that you will focus on if elected (be specific):
Provide a brief summary of what you think are the issues in the coming years and what you will do to address them?
Issue 1:
Issue 2:
Issue 3:
Provide a brief summary of what you have done to support the
Democratic Committee and its platfrom during your tenure in office.
Incumbents Only - Accomplishments:
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Blooming Grove Democrat Committee
Application for Endorsement
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the Town Chair and
contact information will
be removed for Judicial
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