2017 Massachusetts Student Government Day Registration

Massachusetts Student Government Day, sponsored by the Massachusetts Department of Elementary and Secondary Education (ESE), is a statutory program that encourages students from Massachusetts high schools to learn about the structure of state government, to become engaged citizens, and to develop an understanding of the rights and responsibilities that we share in a democracy.

Students assemble at the State House on Friday, April 7, 2017, where most of them will replicate activities of the General Court (Massachusetts state legislature), while others will meet with constitutional officers (Governor, Lt. Governor, Secretary of the Commonwealth, etc.) and members of the Supreme Judicial Court.

Registrations for Student Government Day are made on a first-come, first-served basis. Schools are allowed to register one student designee and one alternate, who are either juniors or seniors. Further information about Student Government Day can be found on the Student Government Day website (http://www.doe.mass.edu/famcomm/student/sgd_program.html). Thank you for your cooperation; we look forward to your participation in Student Government Day.

IMPORTANT - Student consent forms are now required. In order to submit the registration form for Student Government Day, the school must assure that the selected student(s) are over the age of 14 and that they have read and signed the Consent Form for Student Government Day Activities (http://www.doe.mass.edu/famcomm/student/sgd-consent.pdf). The school further assures that it will keep the original signed consent form on file and that, upon request, it will provide the consent form to the Massachusetts Department of Elementary and Secondary Education.

1. Student DESIGNEE for Massachusetts Student Government Day Please enter student home address information below. *This question is required.

First Name
Last Name
Address Line 1
Address Line 2
City/Town
State
Zip Code

2. Student DESIGNEE'S current elected STATE senator in the Massachusetts GENERAL COURT (Massachusetts state legislature) *This question is required. INSTRUCTIONS: The following information is required and must be accurate in order to register for Student Government Day. Please enter in the field below your current elected STATE senator (not UNITED STATES senator) in the Massachusetts General Court (Massachusetts state legislature). This information, based on the student's own home address (not his or her school address or any other address) can be obtained at the following website: http://www.malegislature.gov/People/FindMyLegislator

3. Student DESIGNEE'S current elected STATE representative in the Massachusetts GENERAL COURT (Massachusetts state legislature) *This question is required. INSTRUCTIONS: The following information is required and must be accurate in order to register for Student Government Day. Please enter in the field below your current elected STATE representative (not UNITED STATES representative) in the Massachusetts General Court (Massachusetts state legislature). This information, based on the student's own home address (not his or her school address or any other address) can be obtained at the following website: http://www.malegislature.gov/People/FindMyLegislator

4. Student ALTERNATE for Massachusetts Student Government Day *This question is required.

First Name
Last Name
Address Line 1
Address Line 2
City/Town
State
Zip Code

5. Student ALTERNATE'S current elected STATE senator in the Massachusetts GENERAL COURT (Massachusetts state legislature) *This question is required. INSTRUCTIONS: The following information is required and must be accurate in order to register for Student Government Day. Please enter in the field below your current elected STATE senator (not UNITED STATES senator) in the Massachusetts General Court (Massachusetts state legislature). This information, based on the student's own home address (not his or her school address or any other address) can be obtained at the following website: http://www.malegislature.gov/People/FindMyLegislator

6. Student ALTERNATE'S current elected STATE representative in the Massachusetts GENERAL COURT (Massachusetts state legislature) *This question is required. INSTRUCTIONS: The following information is required and must be accurate in order to register for Student Government Day. Please enter in the field below your current elected STATE representative (not UNITED STATES representative) in the 187th Massachusetts General Court (Massachusetts state legislature). This information, based on the student's own home address (not his or her school address or any other address) can be obtained at the following web site: http://www.malegislature.gov/People/FindMyLegislator

7. Name of one Faculty Advisor to student DESIGNEE and ALTERNATE for Student Government Day. *This question is required.

Faculty Advisor's Email Address (NOTE: All communication and reminders about the event will be sent to this address. It is the responsibility of the Faculty Advisor to share this information with the students.)

*This question is required. Please check your spelling, since your email address will be our primary means of communication.

9. Please indicate adult chaperones who will be attending Student Government Day with the student DESIGNEE and student ALTERNATE. If more than 3 adults will be attending as chaperones please email studentgovday@doe.mass.edu with additional names.

Chaperone #1
Chaperone #2
Chaperone #3

10. Will any person in your group require a reasonable accommodation to participate in Student Government Day? If so, we will contact you. *This question is required.

11. If you have answered YES to the previous question, please indicate the type of accommodation that is required.

12. School that the student DESIGNEE and student ALTERNATE for Student Government Day attend. *This question is required.

School Name (Please provide full name; no abbreviations)
Address Line 1
Address Line 2
City/Town
State
Zip Code
School Phone
School DISTRICT Name (Please provide full name; no abbreviations)

13. Please provide the name and email address of the individual who has completed and submitted this registration. *This question is required.

Name
Email Address

IMPORTANT
By submitting this form, the school assures that the student(s) whose names are listed on the form are over the age of 14 and that they have read and signed the Consent Form for Student Government Day Activities. The school further assures that it will keep the original signed consent form on file and that, upon request, it will provide the consent form to the Massachusetts Department of Elementary and Secondary Education.