Online Election Judge Application

Are you registered to vote in Maryland?

Yes

Title

First

Middle

Last

Suffix

Degree

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

County of Residence

Party Affiliation

Is your mailing address different from the address given above?

Yes

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Daytime Phone

Evening Phone

Cell Phone

Email Address

Additional Email Address

Date of Birth

Are you a county or state employee?

Yes

Are you able to speak, read, or write English?

Yes

Are you bilingual?

Yes

If yes, what languages?

Do you have a drivers license?

Yes

Do you have a car?

Yes

Are you a high school or college student?

Yes

Computer Experience

High

Medium

Low

Signature

By submitting this form, I certify that the information contained in this form is correct to the best of my knowledge.

Date

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