Candidate Interview Request Form - Grassroots America

Candidate Interview Request

The requested information below is mandatory before any interview and will be used for financial, criminal, and voting history background checks. Please use 'None' for any fields that do not apply to your campaign and use '(555) 555-5555' if you do not have a Consultant or Campaign Manager as all fields are required.

Candidate Process PDF(Required)

Yes, I have read the Candidate Review Process PDF

Candidate Name(Required)

Name as on voter registration

First Middle Last

VUID(Required)

Voter Unique ID #

Birth Name(Required)

As reads on your Birth Certificate.

Date of Birth(Required)

For background check.

City of Birth(Required)

City of Residence(Required)

County of Residence(Required)

Desired Office(Required)

Include appropriate District #, Place #, Precinct # as listed on ballot.

Candidate Cell Phone(Required)

Email for Zoom Meeting Invite(Required)

Daily Monitored Email(Required)

Enter Email Confirm Email

Consultant Name(Required)

Consulting Firm Name(Required)

Consultant Phone #(Required)

Consultant Email(Required)

Campaign Manager Name(Required)

Campaign Manager Phone #(Required)

Campaign Manager Email(Required)

Official Campaign Facebook Link(Required)

Personal Facebook Link(Required)

Official Campaign X (Twitter) Link(Required)

Personal X (Twitter) Link(Required)

YouTube Channel Links(Required)

Rumble Channel Links(Required)

All other social media accounts.(Required)

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