APPLICATION FOR ENDORSEMENT BY THE

FAIRFAX COUNTY DEMOCRATIC COMMITTEE

For
At Large School Board Members – 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 $300 Filing Fee
to the FCDC office by 5:00 PM on April 1, 2011. The office address is 2815 Hartland Road, Falls Church VA 22043.

The candidate understands that he or she will be interviewed in person by FCDC 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: At Large 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. I
certify 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 Date

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