Grand Chapter of Washington
UNIFORM CANDIDATE INFORMATION SHEET
Name	Click or tap here to enter text.
Address	Click or tap here to enter text.
Phone	Click or tap here to enter text.
e-Mail	Click or tap here to enter text.
Filing For
I am filing out of	Click or tap here to enter text.	Chapter No.
I am filing out of	Click or tap here to enter text.	Chapter No.
(You must be a PM or PP of the above chapters. BL IV, Section 402, 1 b)
Joined Order of Eastern Star (date)	Click or tap here to enter text.
Year(s) served as Worthy Matron or Worthy Patron	Click or tap here to enter text.
Offices held	Click or tap here to enter text.
Served on the following Grand Chapter Committees	Click or tap here to enter text.
PAGO (enter office)	Click or tap here to enter text.	Year	Click or tap here to enter text.
Former Grand Representative of (jurisdiction)	Click or tap here to enter text.	Year	Click or tap here to enter text.
Past Deputy Instructor	Year(s)	Click or tap here to enter text.
Past Deputy Instructor Chairman	Year	Click or tap here to enter text.
Proficiency	Year (obtained)	Click or tap here to enter text.
Masonic Youth Groups with whom I have worked	DeMolay	Job’s Daughters	Rainbow for Girls
Majority Member of	Choose a group
Positions held in groups:	Click or tap here to enter text.
Occupation (now)	Click or tap here to enter text.	Retired Profession	Click or tap here to enter text.

List leadership roles you have held in Civic/Community Organizations:
Click or tap here to enter text.

What inspired you to file for an elective office?
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What legacy do you hope to leave?
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HOW DO YOU WANT YOUR NAME TO APPEAR ON THE BALLOT? Click or tap here to enter text.

A prospective candidate for elective office may declare to the Grand Secertary in writing at least ninety (90) days but not sooner than one hundred and twenty (120) days prior to an election, her, or his intention to seek a specific office. By-Laws Section 402, Letter a (The date is calculated by starting on the Tuesday date of Grand Chapter and counting back 120 days. Filings received prior to the 120 days or after the 90 days will be destroyed.)

UCIS.docm dtd 02/13/2025