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Poll Worker Interest Form

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. Optional: 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.
    
    - Chelsea City, Dexter City, Saline City, Bridgewater Township, Dexter Township, Lodi Township, Scio Township, & Webster Township have met their recruitment goals and are not in need of any additional Poll Workers.
    
    - Ann Arbor City, Ypsilanti City, Ann Arbor Township & Milan City are recruiting Poll Workers who affiliate with the Republican Party, only, at this time.
    
    

    1. City of Ann Arbor (Recruiting Republicans only)
    2. City of Milan (Recruiting Republicans only)
    3. City of Ypsilanti (Recruiting Republicans only)
    4. Ann Arbor Township (Recruiting Republicans only)
    5. Augusta Township
    6. Freedom Township
    7. Lima Township
    8. Lyndon Township
    9. Manchester Township
    10. Northfield Township

    1. Pittsfield Township
    2. Salem Township
    3. Saline Township
    4. Sharon Township
    5. Superior Township
    6. Sylvan Township
    7. York Township
    8. Ypsilanti Township
    9. No Preference - I'll go where I'm needed
25. Other cities / townships I would consider working in if my first choice is full:

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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