Form Center

Poll Worker Availability Survey

2. Name*
3. Email Address*
5. Address*
7. City*
8. State
9. Zip Code*
11. Phone Number*
12. Are you still interested in being a Poll Worker?*

    1. Yes
    2. No
14. 2021 Elections

    Election dates for 2021 are listed below. Please check the box next to each Election you are able to work.

    1. March 9, 2021
    2. May 18, 2021
    3. August 31, 2021
    4. November 2, 2021
15. Mandatory Training*

    Please mark if you will be available during the following weeks to attend training. (If you are not available for training you will not be able to work until the next Election).

    1. Week of Feb 17 or Feb 24
    2. Week of Apr 27 or May 4
    3. Week of Aug 10
    4. Week of Oct 12 or Oct 19
17. Are you interested in becoming a Chief Judge?*

    1. Yes
    2. No
18. Are you interested in attending a hands-on training workshop?*

    1. Yes
    2. No
20. Are you willing to be a substitute Poll Worker?*

    1. Yes
    2. No
22. Poll Worker Expectations
    Poll Worker Expectations (PDF)
Leave This Blank:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

* indicates a required field