High School Senior Precinct Election Official Program

Voluntary Off-School Site Election Activity

This form is a student application. It also informs you, as a parent or guardian that a voluntary, off-school site activity will take place and secures authorization for your son or daughter to participate in this activity. Students must inform after-school employers, team coaches, or other relevant persons that they must be available for training on (date and time to be announced) and will be working at the polls all day and evening on (DATE).

STUDENT APPLICATION FORM

(Please print all information and sign in INK where noted.)

School District: School Name:

Student’s Full Legal Name: Date of Birth:

Student Home Address:

City: Zip Code:

Cell Phone Number: ( ) Home Phone Number: ( )

Social Security #: (Required for board of elections payroll purposes)

Email Address: Party Affiliation: ______

Please select one of the three items below (X):

____ I have attached my completed VOTER REGISTRATION form, OR

____ I am ALREADY registered to vote in ______County, OR

____ I am not eligible to register to vote because I will not turn eighteen until after the general election.

My signature below indicates that I meet the following criteria:

ü I am a student in good standing.

ü  I will attend a required training session prior to election day.

ü  I will commit to be at the polling location from ______AM to 8:30 PM or later (when I am dismissed by the presiding judge).

ü  I have informed my team coaches, employer and other relevant persons of my commitment.

ü  I have my own transportation to and from the polls on Election Day.

ü  I am willing to work at any ______County polling location, and I understand that there are a limited number of high school students permitted by law to work in ______County.

Student Signature: Date:

PARENT/GUARDIAN PERMISSION AND NOTIFICATION FORM

I have reviewed and understand the conditions of the voluntary, off-school site activity described and give consent for my child to participate. I understand that the location of this off-site activity will be at a polling place within ______County. I give permission for my child to be photographed at this event. I understand that my child may participate only if ALL information is completed correctly on this form.

Signature of Parent or Guardian: ______Date: ______

Address: ______

Phone Number: (daytime) ______(evening) ______

Event Information: Date: ______Start Time: End Time: When excused, about 8:30 PM
Nature of Activity: Serve as Precinct Election Official on Election Day within County.
Location: Polling place (Exact location to be specified at a later date.)
Dress: Shirt or blouse and dress pants or skirt (no denim/jeans, no sandals or flip flops)
«STUDENTS ARE ENCOURAGED TO BRING A BAG LUNCH AND WATER«
For Additional Information, Call: County Board of Elections: ( )
School Official Verification: Student is a High School Senior? Yes No
Faculty Member Sponsor: Signature: ______
STUDENTS: This form must be returned to your sponsoring teacher along with your completed voter registration form (if not already registered). Please remember you must attend training prior to serving as a precinct election official and must work the entire day on Election Day: ______/ TEACHER/ADVISOR: Keep a copy of this form on file as required by your School District. Send the original permission form and voter registration form to: ______County Board of Elections (Address: ______)