Dayton Christian High School

Student Government 2010-2011

Nomination Form

NAME: ________________________________

OFFICE: (circle only one) President Vice-President

Chaplain Secretary

Treasurer Student Senate

CLASS: (circle the class you will be in next year)

Freshman Sophomore Junior Senior

Are you registered as a student at DCHS for next year? Yes No

You will not be allowed to run for office if your re-registration form is not received by the
Business Office by 8:00 am Thursday, April 8, 2010.

Have you ever been in the office for a discipline situation other than a dress code?
Yes No If yes, please explain: _________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

What is your cumulative GPA? ________

What is your first semester (2009-2010) GPA? ________

You must have a minimum of 2.8 for either your cumulative or current GPA in order to run for
office.

Were you absent more than 15 periods for any single class during first semester (2009-
2010)? Yes No
Please verify your attendance with the Attendance Secretary and obtain her signature below. You
will not be allowed to run for office if you missed more than 15 periods total of any class during the first
semester (2009-2010).

Attendance Secretary’s Signature: _____________________________ Date: ____________

Over

List all your current teachers:

1._____________________________ 5._____________________________

2._____________________________ 6._____________________________

3._____________________________ 7._____________________________

4._____________________________ 8._____________________________

Please write out your testimony below. If more space is needed, attach a separate piece of
paper to the back of this form.

Please read the following and sign below:

I understand that all nominations will be reviewed at a teachers’ meeting for faculty approval. I
understand that these are the minimum requirements necessary to run as a class officer candidate for the
2010-2011 school year. I also understand that I will not be allowed to run for office if my re-registration
is not received by the Business Office by 8:00 am Thursday, April 8, 2010. I further understand that there
will be no exceptions to this deadline.

Student Signature: _____________________________ Date: ____________

Parent Signature: _____________________________ Date: ____________

• Both signatures are required in order to run for office

• Verbal confirmation will not be accepted

This completed form must be returned to the school office no later than
3:00 pm Thursday, April 8, 2010.