Fillable Student Election Clerk Application And Permission Form printable pdf download

Student Election Clerk Application And Permission Form

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Student Election Clerk Application and Permission Form

Name of Student _________________________________ Date of Birth _____________________

Home Address ___________________________________ Telephone Number ________________

School Attending _________________________________ Election Date ____________________

Student Affidavit: By signing this application, I acknowledge the following:

 I am interested in working the following election(s) ____________________ (election date).

 I am/will be at least 16 years of age on Election Day.

 I am currently enrolled at _____________________________ (name of school).

 I am a United States citizen.

 I will complete the required training course prior to Election Day.

 I agree to obtain an excused absence from my school office for Election Day. I will

promptly notify the election office if I am unable to obtain an excused absence. It is my

responsibility to collect and complete any and all school assignments for the day.

__________________________________________

____________________

(signature of student)

(date)

Parent/Legal Guardian Permission: This is to certify that I give permission for my son/daughter,

named above, to serve as a student election clerk for _____________________________(election).

_________________________________________

____________________

(signature of parent/legal guardian)

(date)

_________________________________________

____________________

(print name)

(telephone number)

School Principal Permission: This is to certify that the student named above is currently enrolled

at __________________________________ (name of school) and has my consent to serve as an

election clerk on _____________________ (date).

_________________________________________

____________________

(signature of principal)

(date)

_________________________________________

(print name)

(Home-schooled students must have the Parent/Legal Guardian Permission section completed by the parent/legal

guardian responsible for their education.)

Send the completed form to your local elections office conducting the election for which you wish

to serve (county clerk/elections administrator, city secretary, school superintendent, etc.). For more

information about elections, go to the Secretary of State’s website at

Student Election Clerk Application And Permission Form

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