Shelley Moore Capito - Congresswoman

Congresswoman Capito's office provides a number of important opportunities for students seeking to learn about their federal government, for those seeking to attend one of America's service academies and for students looking for information about financial aid.

To learn more, please click one of the links below.

Student Advisory Committee: Parental Permission Form

TO:      Congresswoman Shelley Moore Capito

C/O Mary Elisabeth Eckerson

4815 MacCorkle Ave., SE
Charleston, WV 25304
Phone: 304.925.5964
Fax: 304.926.8912

Re: Parental Permission Form

I, _________________________ (parent name), hereby grant permission for my son/daughter, __________________ (student name), to participate in the 2010-2011 Student Advisory Committee sponsored by Congresswoman Shelley Moore Capito, WV-2.

Address:___________________________________________________________________

Phone:_____________________________________________________________________

Emergency Contact:___________________________________________________________

Email:______________________________________________________________________

Signature:___________________________________________________________________

Anticipated Schedule (subject to change):

            October 30,2010: Kick-off reception with Congresswoman Shelley Moore Capito

            February 13, 2010: Guest Speaker

            April 10, 2010: Guest Speaker

            May 22, 2010: Graduation and reception (parents invited to attend)

Please sign and return this form to the address listed above. 

For more information, visit www.capito.house.gov or contact my District Director, Mary Elisabeth Eckerson, at 304-925-5964. 

Sincerely,

Member of Congress