Become a Poll Worker!

Please fill in the boxes below. Use the TAB key to move forward and press SHIFT TAB to move backwards. When finished, click on the Submit Form button to send an email informing the board of elections in your interest to become a poll worker.

If you are registered voter, click here to locate your name and prefill the form. Once found, you must click on the link to request absentee ballot.

Voter's Name:  Required

Birth Year:  Required

Residence Address

Street Address:  Required

City:  Required

Zip Code:  Required

Mailing Address (If different than residence)

Mailing Address:

City:

State:

Zip Code:

Contact Information

Daytime telephone number:  

Other telephone number:  

E-mail address  Required 

Party Affiliation

Democratic

Republican

Unknown

Are you willing to work outside of your precinct?

Yes

No

Additional Comments: