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Please complete this form.

1. ASPIRANT INFORMATION

Full Name

Date of Birth

Gender

State Of Origin

Local Government of Origin

2. EDUCATION & EMPLOYMENT INFORMATION

Highest Qualification:

Employment Status:

How Long:

Position:

3. POLITICAL INFORMATION

Have you run for office before?

Tick as appropriate

If yes, under which party did you contest?

Did you participate in the party primaries?

Did you win your party primaries?

did you win the election?

What office will you run for in 2019?

For what constituency? (House of Reps and state assembly only)

Political Party?

Tell us why you want to run for office?

4. THREATS TO YOUR POLITICAL ASPIRATION

Select as appropriate

4. Contact Information

Phone Number

E-Mail

Residential Address

Website

Twitter ID

Facebook ID

Instagram ID