NOMINATION PETITION FOR PIAA DISTRICT IX COMMITTEE 

Check seat(s) you are seeking:

_____  at large               _____  junior high/middle school (even years only). 

I, ______________________________, currently employed by the ___________________________________

School District am actively seeking a seat on the District IX Committee. 

I have received endorsements from the following principals from separate school districts.  Their names,

signatures,  and schools appear below.  It is noted that a principal may sign only one candidate’s petition.

NAME                                             SIGNATURE                                    SCHOOL

________________________     ___________________________     _________________________

________________________     ___________________________     _________________________

________________________     ___________________________     _________________________ 

I understand that the Secretary/Treasurer of the District IX Committee must receive this completed form by March 1. 

_______________________________ Petitioner’s Signature      Date _________________________