National Voter Registration Application Form For U.s. Citizens Page 3
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25Application Instructions
Before filling out the body of the form, please answer the questions on the top of the form as to whether you are a
United States citizen and whether you will be 18 years old on or before Election Day. If you answer no to either of these
questions, you may not use this form to register to vote. However, state specific instructions may provide additional
information on eligibility to register to vote prior to age 18.
Box 1 — Name
Box 7 — Choice of Party
Put in this box your full name in this order — Last,
In some States, you must register with a party if you
First, Middle. Do not use nicknames or initials.
want to take part in that party’s primary election,
Note: If this application is for a change of name, please
caucus, or convention. To find out if your State requires
tell us in Box A (on the bottom half of the form) your
this, see item 7 in the instructions under your State.
full name before you changed it.
If you want to register with a party, print in the box the
Box 2 — Home Address
full name of the party of your choice.
Put in this box your home address (legal address). Do
If you do not want to register with a party, write “no
not put your mailing address here if it is different from
party” or leave the box blank. Do not write in the word
your home address. Do not use a post office box or
“independent” if you mean “no party, ” because this
rural route without a box number. Refer to state‑specific
might be confused with the name of a political party in
instructions for rules regarding use of route numbers.
your State.
Note: If you were registered before but this is the first
Note: If you do not register with a party, you can still
time you are registering from the address in Box 2,
vote in general elections and nonpartisan (nonparty)
please tell us in Box B (on the bottom half of the form)
primary elections.
the address where you were registered before. Please
Box 8 — Race or Ethnic Group
give us as much of the address as you can remember.
A few States ask for your race or ethnic group, in order
Also Note: If you live in a rural area but do not have a
to administer the Federal Voting Rights Act. To find
street address, or if you have no address, please show
out if your State asks for this information, see item 8
where you live using the map in Box C (at the bottom
in the instructions under your State. If so, put in Box 8
of the form).
the choice that best describes you from the list below:
American Indian or Alaskan Native
•
Box 3 — Mailing Address
•
Asian or Pacific Islander
If you get your mail at an address that is different from
•
Black, not of Hispanic Origin
the address in Box 2, put your mailing address in this
•
Hispanic
box. If you have no address in Box 2, you must write in
•
Multi‑racial
Box 3 an address where you can be reached by mail.
White, not of Hispanic Origin
•
Box 4 — Date of Birth
•
Other
Put in this box your date of birth in this order —
Box 9 — Signature
Month, Day, Year. Be careful not to use today’s date!
Review the information in item 9 in the instructions
Box 5 — Telephone Number
under your State. Before you sign or make your mark,
Most States ask for your telephone number in case
make sure that:
there are questions about your application. However,
(1) You meet your State’s requirements, and
you do not have to fill in this box.
(2) You understand all of Box 9.
Box 6 — ID Number
Finally, sign your full name or make your mark, and
Federal law requires that states collect from each
print today’s date in this order — Month, Day, Year.
registrant an identification number. You must refer to
If the applicant is unable to sign, put in Box D the
your state's specific instructions for item 6 regarding
name, address, and telephone number (optional) of the
information on what number is acceptable for your
person who helped the applicant.
state. If you have neither a drivers license nor a social
security number, please indicate this on the form and a
number will be assigned to you by your state.
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