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2. Contact Information
4. First Name*
5. Last Name*
7. Address 1
9. Address 2
11. City
12. State
13. Zip
15. Phone Number*
17. Email Address*
19. How did you hear about becoming a Poll Worker?
    Who referred you to this page (i.e. What organization? Another Poll Worker? What website?) Please let us know.
21. Please declare your major or minor political party preference. *

    1. Democratic Party
    2. Republican Party
    3. Libertarian Party
    4. US Taxpayers Party
    5. Green Party
    6. Natural Law Party
    7. Working Class Party

    Note: Michigan law requires that Poll Workers declare their political party affiliation in order to be appointed by the City or Township Election Commission. Poll Workers may indicate a major party or one of several recognized minor parties. "Independent" is not a recognized party affiliation for Poll Workers under Michigan law. If you choose not to respond to this question now, it's ok, however you will need to declare your party affiliation to the City or Township Clerk on your formal Poll Worker application.

23. I am interested in serving as a Poll Worker in the following location:

    - Please select ONE first choice. You may provide additional choices in the text box below.

    - Note: If you do not see your preferred jurisdiction listed below, it has met it's recruitment goal already and is not in need of additional poll workers. Please consider choosing another jurisdiction.

    
    

    1. City of Ann Arbor
    2. City of Dexter
    3. City of Milan
    4. City of Saline
    5. City of Ypsilanti
    6. Ann Arbor Township
    7. Augusta Township
    8. Bridgewater Township
    9. Dexter Township
    10. Lima Township

    1. Lyndon Township
    2. Northfield Township
    3. Salem Township
    4. Saline Township
    5. Scio Township
    6. Sharon Township
    7. Superior Township
    8. Sylvan Township
    9. York Township
    10. Ypsilanti Township
25. Other cities / townships I would consider working in if my first choice is not in need of poll workers:
27. A poll worker must be a registered voter in the State of Michigan. Exception: individuals age 16-17 not yet registered to vote but who will be qualified to register to vote when they meet the minimum age may serve as poll workers. A poll worker cannot be a challenger, candidate, member of a candidate's immediate family, or a member of the local Board of Canvassers. Anyone convicted of a felony or an election crime may not serve.
29. Please note that if your requested location is not in need of poll workers your information may be passed along to another city or township where poll workers are needed.
31. Date
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit Submit and Print

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