Step 1 of 4 25% 2025 Reorganization Self Nomination Thank you for nominating yourself for a leadership position with the 5th District Democrats. The 2025 Reorganization Meeting of the 5th District Democrats will be held via Zoom at 7.00pm on Wednesday 22nd January 2025. Any Democrat who is a resident of the 5th Legislative District can run for any Executive Board position or committee chair position. As we choose these leaders, we strive to include persons that represent the diversity of our district including gender, race, age, religion, sexual orientation, economic status, and ethnic origin, as well as the district’s diverse geographical areas, cities, and towns. Therefore, we will be asking you to identify these traits in the following nomination form. If you have questions please contact [email protected] Name(Required)Please enter your name. First Last Consent(Required)When you complete and submit this form, we collect some information from you and your device. You will be required to enter your: name, e-mail address, mailing address, and phone number. You will also be asked to provide your identified gender, which leadership position you are standing for, and a candidate statement. Information about your computer (e.g., IP address) may be collected. A small file, or browser cookie, may be used to record previous visits to the survey to enforce limits on the number of times a participant can respond/vote. We use the data we collect for the purposes of securely administering the 2025 reorganization. We keep the data for as long as necessary to accomplish these purposes. I agree to the privacy policy. Address(Required)Please enter your address. This is used to validate your residence within the 5th Legislative District. Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email(Required)Please enter your email address. This is used for communication. Phone(Required)Please enter your preferred contact phone number. This is used for communication.Which most closely identifies your gender?(Required)This is used to ensure gender balance for our Statutory, State Committee and KCDCC Delegate positions. "Other" includes transgender, non-binary, agender and other descriptions. Woman Man Other Leadership position(Required)Please indicate which leadership position(s) you are nominating yourself for. A full list, with descriptions of roles, gender balance requirements, and other information is available at https://5thdems.org/reorganization-2025-open-leadership-positions/ Chair First Vice-Chair State Committee Member KCDCC Delegate KCDCC Alternate Young Democrat Young Democrat Alternate Second Vice-Chair Secretary Treasurer PCO Chair Membership Communications Technology Endorsements Rules & Bylaws Platform & Resolutions Legislative Action & Advocacy Environment Fundraising Festivals Diversity & Inclusion Young Leaders Candidate Statement(Required)Please provide a concise statement regarding your nomination. This will be posted to the 5th Legislative District Democrats website https://5thdems.org PhotoOptional photo. Upload only JPG or PNG images. Max file size is 10MB. Photos may be cropped or resized to fit.Accepted file types: png, jpg, Max. file size: 10 MB.EmailThis field is for validation purposes and should be left unchanged. Δ
