New American Independent Party

ONLINE CANDIDATE
APPLICATION
FORM

First & Last Name

Address 1

Address 2

Town / City

State

+ 4 (0000)
if known

Zip Code

Phone Number

If so, which hours
or days do you
prefer?

Can we call
you?

NOTE: ALLOWING US TO SPEAK TO YOU BY PHONE WILL GREATLY SPEED
UP THE PROCESS. BUT, CONTACT BY PHONE IS NOT REQUIRED.

Email Address

Office level you are
seeking?

Year you intend on
running for office?

Office
you are
Seeking?

Other office
not listed
above

List your top 3 or 4 issues
that you want to run on or
what you hope to
accomplish

Have you ever
ran for public
office before?

YES

If yes, please expain (i.e. year &
position sought)

Have you ever been charged
with committing a crime?

Have you ever been convicted
of a crime?

Do you owe back taxes?

Are you familiar with the
NAIP/SRP Platform/ Issues?

Do you agree with the New
American Independent Party
/Self Reliance Party on most
issues? (We don't expect you
to agree with the platform on
every single issue)

Are you committed to helping
the NAIP/SRP grow and
become a powerful political
force in America?

Are you committed to running
under either the "New
American Independent Party"
or the "Self Reliance Party"
ballot label?

COMPLETE A CANDIDATE QUESTIONNAIRE FORM

NATIONAL (Long Form)
(ATTACH A CURRENT RESUME)

STATE (Short Form)
(RESUME ENCOURAGED, NOT REQUIRED)

LOCAL (Short Form)
(NO RESUME REQUIRED)

To request a NAIP candidate questionnaire please email:
action@newamericanindependent.com
Please indicate which questionnaire form you are requesting (local, state or
national)

STEP 1:

FILL OUT AND SUBMIT A CANDIDATE DECLARATION FORM
To request a NAIP candidate declaration form please email:
action@newamericanindependent.com
2010 CANDIDATE DECLARATION FORM
(Must be signed by a Notary Public)

2011 CANDIDATE DECLARATION FORM
(Must be signed by a Notary Public)

2012 CANDIDATE DECLARATION FORM
(Must be signed by a Notary Public)

STEP 3:

STEP 2:

STEP 4:

If you haven't already, please sign up
for our email alerts. You will be placed
on the candidates email list in addition
to the general list.

Join Our Mailing List