CEA Advocacy Request Form

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This form is for our CEA members to report site advocacy issues to the CEA Executive Board. While we prefer that members report these issues to the Site Representative(s) and have their Representative complete this form, it may be appropriate in some cases for members to directly report issues using this form.

If indicated on this form, your advocacy request will be reported to your assigned Executive Board liaison, who will follow up with you as needed.

What is your name? *

What is your work site? *

Which statement best describes your role? *

I am a CEA member submitting my own advocacy request

I am a CEA Site Representative submitting a request on behalf of a member at my site

What is the subject of your request? *

Evaluations

Policies/Procedures Inquiry

Interactions with Colleagues

Interactions with Admin

Other:

Please summarize the incident with which you need assistance. *

Would you like your Executive Board liaison to follow up with you? *

If you answer "Yes", please share your contact information below.

Yes

What is your personal email address?

What is your phone number?

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This form was created inside of Chandler Education Association.