Student Poll Worker Interest Form

Requirements

If you are interested in becoming a student poll worker in Pennsylvania, complete and submit this form. To serve as a poll worker, students must be at least 17 years of age and obtain permission from their principal and parent/guardian to serve as a poll worker. Your information will be sent to the county election office where you live. Problems with this form? Call 1-877-VOTESPA (1-877-868-3772) or email ra-voterreg@pa.gov.

Required fields are marked with an asterisk.(*)

By completing this form, I confirm:

I am enrolled in a secondary educational institution and in good academic standing.

I agree to attend any mandatory training.

I understand that election day runs from before the polls open at 7:00 a.m. until after the polls close at 8:00 p.m.

I am a US citizen.

Contact Information

First name

Last name

Date of birth

Residential Address

City

State

ZIP code

County of Residence

Phone Type

Primary phone number

Phone Type

Alternate phone number

Email Address

Additional Information

Are you willing to travel within the county on election day?

If there are no vacancies now, may we contact you in the future?

Are you able to assist voters in a language other than English (including American Sign Language)?

If so, what language(s) do you speak, read, and write?

How fluent are you?

How did you find out about this opportunity?

Generate a new image Play the audio code

Enter the code from the image