Better Schools, Better Jobs Signature Collection Form
Field Staff Name
*
Please Select
Charles Taylor
Amber Thomas
Patsy Brumfield
Mike Morris
Blake Case
Jeremy Sanford
Charles Hampton
K.C. Grist
Brentton Jackson
Tyson Jackson
Trishtian Clayton
Luis Williams
Kameka Miller
Joseph McKee
Jeremy Pittman
Jed Oppenheim
Francine Jefferson
Doriecia Washington
Kimar Cain
Tasha Dillon
Robin Haney
Norman Handy
Venue (location)
*
City
*
Enter the number of signatures you have collected
*
Enter the # of errors found in collecting your signatures (wrong color ink, illegible text, incomplete information, etc...)
*
Date Collected
*
-
Month
-
Day
Year
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Date Reported
*
-
Month
-
Day
Year
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Select district of petition signer.
*
District 1
District 2
District 3
District 4
District 5
District 1 - County Listing
Alcorn
Benton
Calhoun
Calhoun
Chickasaw
Choctaw
Desoto
Grenada
Lafayette
Lee
Marshall
Monroe
Panola
Pontotoc
Prentiss
Tate
Tippah
Union
Webster
Yalobusha
Comments, concerns, notes, etc.
Submit
Clear Form
District 2 - County Listing
Attala
Bolivar
Carroll
Claiborne
Coahoma
Grenada
Hinds
Holmes
Humphreys
Issaquena
Jefferson
Leake
Leflore
Madison
Montgomery
Panola
Qutiman
Sharkey
Sunflower
Tallahatchie
Tunica
Warren
Washington
Yazoo
Comments, concerns, notes, etc.
Submit
Clear Form
District 3 - County Listing
Attala
Clarke
Clay
Jasper
Jones
Kemper
Lauderdale
Leake
Lowdnes
Madison
Neshoba
Newton
Noxubee
Oktibbeha
Rankin
Scott
Smith
Wayne
Winston
Comments, concerns, notes, etc.
Submit
Clear Form
District 4 - County Listing
Adams
Amite
Copiah
Covington
Franklin
Hinds
Jefferson-Davis
Jones
Lawrence
Lincoln
Marion
Pike
Simpson
Walthall
Wilkson
Comments, concerns, notes, etc.
Submit
Clear Form
District 5 - County Listing
Forest
George
Greene
Hancock
Harrison
Jackson
Lamar
Pearl River
Perry
Stone
Wayne
Comments, concerns, notes, etc.
Submit
Clear Form
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