Nebraska Administrative Code › Topic - EDUCATION, DEPARTMENT OF › Title 92 - NEBRASKA DEPARTMENT OF EDUCATION › Chapter 64 - PROCEDURES FOR NEGOTIATED RULEMAKING › Attachment 92-64-3

Current through June 17, 2024
BEFORE THE STATE DEPARTMENT OF EDUCATION STATE OF
				  NEBRASKA
In the Matter of the Negotiated )
				  Application/Nomination
Rulemaking Committee for ) for membership
[Insert name of the proposed ) on the committee
Negotiated Rulemaking Committee], ) (interest
				  inadequately
____ NAC ____ . ) represented)
APPLICATION FOR MEMBERSHIP
(complete if applicable)
1. The undersigned person (the applicant)
				hereby applies for membership on the above-referenced negotiated rulemaking
				committee.
___________________________________
Name of applicant (typed or printed)
__________________________________________________
Full address of applicant
__________________________________
Applicant's telephone number (including area code)
2. The applicant represents the
				following identifiable interest which will be significantly affected by the
				proposed administrative rule being considered by the above-referenced
				negotiating rulemaking committee:
3. The applicant is authorized to represent
				parties related to the interest listed above because:
4. The applicant can adequately represent the
				parties and interest listed above because:
5. Reasons that persons already serving on
				the above-referenced negotiated rule making committee do not adequately
				represent the interest listed in paragraph 2 above include:
6. In support of his or her application, the
				applicant has attached the following documents to this petition (list all
				attachments):
7. By signing this
				application, the applicant hereby certifies that he or she will represent the
				interest identified above to the best of his or her ability in the negotiation
				process, and that he or she is willing to actively negotiate in good faith to
				reach a consensus on the proposed rule being considered by the above-referenced
				negotiated rulemaking committee.
_________________________________ Date
				  _____________________
Signature of Applicant
NOMINATION FOR MEMBERSHIP
(complete if applicable)
1. The undersigned person (the nominating
				party) hereby nominates the following person (the nominee) for membership on
				the above-referenced negotiated rulemaking committee.
__________________________________
Name of nominee (typed or printed)
__________________________________________________
Full address of nominee
___________________________________
Nominee's telephone number (including area code)
2. The nominee represents the
				following identifiable interest which will be significantly affected by the
				proposed administrative rule being considered by the above-referenced
				negotiated rulemaking committee:
3.
				The nominee is authorized to represent parties related to the interest listed
				above because:
4. The nominee can
				adequately represent the interest listed above because:
5. Reasons that persons already serving on
				the above-referenced negotiated rule making committee do not adequately
				represent the interest listed in paragraph 2 above include:
6. In support of the nomination of the
				nominee, the nominating party has attached the following documents to this
				petition (list all attachments):
7.
				The nominating party believes that the nominee will represent the interest
				identified above to the best of his or her ability and that the nominee is
				willing to actively negotiate in good faith to reach a consensus on the
				proposed rule to be considered by the above-referenced negotiated rule making
				committee because:
_____________________________________ Date
				  _________________
Signature of Nominating Party
____________________________________________
Name of nominating party (printed or typed)
_________________________________________________________
Full address of nominating party
______________________________________________
Telephone number of nominating party (include area
				  code)