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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. 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.
    
    

    1. City of Ann Arbor
    2. City of Chelsea
    3. City of Dexter
    4. City of Milan
    5. City of Saline
    6. City of Ypsilanti
    7. Ann Arbor Township
    8. Augusta Township
    9. Bridgewater Township
    10. Dexter Township
    11. Freedom Township
    12. Lima Township
    13. Lodi Township
    14. Lyndon Township

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

23. 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.

25. 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.

27. Date

Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit Submit and Print

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