Massachusetts Democratic Party Add On Delegate Application

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Platform Convention: Saturday June 3, 2017 at the DCU Center in Worcester.

Email *

First Name *

Last Name *

Street Address *

City *

Zip Code

Phone *

E-mail *

Please select ONE category *

Applicants for youth positions must be at least age 18 by September 11, 2018 and 35 or under as of June 3, 2017. The youth add-on process gives preference to those who attended their local caucus and those who are active in Democratic organizations. The Democratic Party of Massachusetts, to encourage full participation by all segments of the population, shall conduct Affirmative Action and Outreach Programs on behalf of target groups which include Blacks, Hispanics, Asian Americans, Native Americans and Cape Verdeans. Disability/Handicapped, with respect to an individual, means a physical or mental impairment that substantially limits one or more of the major life activities of such individual, a record of such an impairment, or being regarded as such an impairment.

Youth

Disabled

Minority: Black

Minority: Hispanic

Minority: Asian American

Minority: Native American

Minority: Cape Verdean

Required

I attended my caucus *

Yes

Youth Add-Ons ONLY: Are you active in a Democratic Organization?

Yes

Clear selection

Youth Add-Ons ONLY: If you are active in a Democratic Organization, please specify the organization here.

OPTIONAL: I am requesting the following accommodations

Send me a copy of my responses.

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