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2. STUDENT Online Poll Worker Application For The 2022 Primary Election

   This form is ONLY for STUDENTS who are ages 16 or 17 year old.

4. Please note any question with a red * requires an answer. You will find that almost every question will require an answer. You will not be able to submit this form until all fields with the red * are completed.
6. Contact Information
8. First Name*
   Please use your legal name
9. Last Name*
   Please use your legal name
11. Street Address*
    Please provide the street address where you legally reside
13. City*
14. State*
15. Zip*
17. Home Phone Number*
18. Cell Phone Number*
19. Email Address*
21. What Is The Best Way To Contact You?*

    1. At The Email Address Above
    2. At The Home Number Listed Above
    3. At The Cell Phone Number Listed Above
23. What Is The Best Time To Contact You At That Phone Number?

    1. Weekday Mornings

    1. Week Day Afternoons

    1. Anytime
25. Poll Worker Qualifying Information
27. Are You A US Citizen?*

    1. Yes
    2. No
28. Do You Live In Porter County*

    1. Yes
    2. No
30. Are you the treasurer or chairman of the committee for a candidate on the ballot?*

    1. Yes

    1. No
32. Are a you a candidate on the ballot, or a relative by birth, marriage or adoption of a candidate on the ballot?*

    1. Yes

    1. No
34. What Is Your Date Of Birth?*
    What Is Your Date Of Birth?
35. What Is Your Age?*

    1. Age 16
    2. Age 17
37. What High School Do You Attend?*
    If home schooled, please enter Home Schooled
39. If you are age 16 or 17 and want to be a Poll Worker, you must have the approval of your parent or guardian; you must be a citizen of the United States and a resident of Porter County; and, you must satisfactorily complete the required training class. If school is in session for Election Day, you must have a cumulative grade point average of at least 3.0 on a 4.0 scale; you must have written approval by your principal or, if you are educated at home, the approval of the individual responsible for your education. You will be provided with the necessary forms to meet these requirements, and it is your responsibility to assure that the forms are completed and returned to us on a timely basis or you will not be allowed to work at the polls.*

    1. I Understand & Agree
41. Poll Worker Experience
43. Which Position Are You MOST Interested In Working?*

    1. Judge

    1. Clerk

    1. Election Night Worker
45. Would You Accept Another Position?*

    1. Yes

    1. No
47. In What Township Would You Prefer To Work In?*

    1. Boone Township
    2. Center Township
    3. Jackson Township
    4. Liberty Township

    1. Morgan Township
    2. Pine Township
    3. Pleasant Township
    4. Portage Township

    1. Porter Township
    2. Union Township
    3. Washington Township
    4. Westchester Township
49. If There Are No Positions Open At Your Preferred Township, Would You Consider A Different Location?*

    1. Yes

    1. No
51. Did You Serve As A Poll Worker In The 2020 Primary or General Election?*

    1. Yes

    1. No
53. In Which Did You Serve As A Poll Worker?*

    Check All That May Apply

    1. 2020 Primary Election

    1. 2020 General Election
55. In What Position(s) Did You Work?*

    Check All That Apply

    1. Judge

    1. Clerk
57. Disclosures
59. Until the Chairs of the two major political parties turn in their lists of Poll Worker appointments on April 15th, we will not know how many Poll Worker vacancies will need to be filled, and you may not be contacted until after April 15th if you are selected to be a Poll Worker.*

    1. I Understand & Agree
61. This online form is ONLY an application to become a Poll Worker. Your approval to work at the polls is not guaranteed until you receive a confirmation from the Elections & Registration Office*

    1. I Understand & Agree
63. If you are selected as a Poll Worker, you MUST attend a required training course.*

    1. I Understand & Agree
65. You are almost done! Please click on "Submit" below and you will be directed to a Form Submission Confirmation Page. If you are not directed to the Form Submission Confirmation Page, then you have probably missed providing required information on this form. Please scroll up to see any highlighted fields where an answer is required, then click on "Submit" again.
Leave This Blank:


67. 1. Receive an email copy of this form.
68. Email address

    This field is not part of the form submission.

69. Submit

* indicates a required field