Endorsement Request Form
Please complete this endorsement request form as the first step for endorsement by Elect Black Women PAC. Please complete all sections of the questionnaire. If you have any questions, please contact us at
Info@electblackwomenpac.com
.
Any candidate who receives an Elect Black Women PAC endorsement must agree, win or lose, to stay connected to our community. We know it takes time to elevate our women. Candidates sometimes have to run a few times before they win - 100% of our endorsed candidates will run for office again within 2-4 years with our support, work on another campaign as an operative, or pursue additional leadership roles in their community as an advocate helping to train, support, and Elect Black Women.
Endorsements will be processed every 4-6 weeks until November 8, 2022. Applications received by December 30, 2021, at midnight ET, will be considered/publicly announced as part of the January 13, 2022 endorsement round.
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Email
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Your email
Candidate Name
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Your answer
Candidate Phone Number
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Your answer
Campaign Address
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Your answer
Campaign Phone Number:
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Your answer
Campaign Email Address:
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Your answer
Campaign Website:
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Your answer
Candidate Biography
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Your answer
What office are you running for?
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Your answer
What type of position are you running for?
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Municipal
State
Federal
Judicial
District Number (if applicable)
Your answer
Party Affiliation on the Ballot (If your race is nonpartisan, please let us know.)
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Your answer
Candidate Political Registration/Affiliation:
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Your answer
Candidate race and ethnicity
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Your answer
Rural or Urban
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Rural
Urban
Suburban
Treasurer Name and contact info
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Your answer
Campaign Manager and contact info
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Your answer
Total Budget?
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Your answer
Total Cash on Hand
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Your answer
Money raised to date overall for the campaign?
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Your answer
How do you plan to raise money? Call time, email, PACS, etc.
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Your answer
Spending Priorities:
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Your answer
List of other endorsements
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Your answer
Civic Participation and Community Service
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Your answer
Are you a challenger, incumbent, or is this an open seat?
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Challenger
Incumbent
Open Seat
Are you a first time candidate?
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Yes
No
What are the issues that your campaign platform focuses on?
Your answer
Who else is running in your election? Please list the names of all of your competitors and their party affiliation (if this is a partisan race).
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Your answer
What do you feel are the greatest challenges you will need to overcome to win your election?
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Your answer
Where is your campaign located? (City, County)
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Your answer
Where is your campaign located? (State)
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Your answer
When is the Primary (Day/Month/Year)? Please also include any early voting dates and vote by mail dates for your Primary Election Day.
Your answer
When is the General Election (Day/Month/Year)? Please also include any early voting dates and vote by mail dates for your General Election Day.
Your answer
What is the maximum contribution your campaign can receive from a PAC (what is the contribution limit)?
Your answer
Is there any reason you would decline an Elect Black Women PAC endorsement? For example, you are in a conservative district, concerns about race/identity politics, attacks from other groups, etc. Answering this question honestly will not preclude you from being endorsed, but will help us understand the dynamics of your community.
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Your answer
Please note, our endorsement condition is that our women want to be a part of a broader political community of black women in electoral politics. We encourage our endorsed candidates, win or lose, to stay connected to our community. Candidates sometimes have to run a few times before they win, so having something “next” is powerful. That something next is ensuring that 100% of Elect Black Women PAC endorsed candidates run for office again within 2-4 years, work on another campaign as an operative, or pursue additional leadership roles in their community as an advocate for Elect Black Women.
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Yes! I understand and I am open to being a part of Elect Black Women, regardless of the outcome of my election.
No! I am not open to being a part of the Elect Black Women community, regardless of the outcome of my election.
A copy of your responses will be emailed to the address you provided.
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