Form Center

Poll Worker Application

2. Full Name*

3. Email Address*

5. Address*

7. City*

8. State*

9. Zip Code

11. Home Number

12. Cell Number*

14. Political Party*
    -- Select One --Unaffiliated (No Party)DemocraticRepublicanGreenIndependent PartyOther

15. What is your voting district?*
    -- Select One --1 - Julian Curtis School2 - Greenwich Town Hall3 - Western Middle School4 - New Lebanon School5 - Riverside School6 - Old Greenwich School7 - Greenwich High School8 - Central Middle School9 - Bendheim Greenwich Civic Center10 - Glenville School11 - North Street School12 - North Mianus SchoolNone - I am not registered to vote in Greenwich, but I am registered to vote in CT.I am not registered to vote in Greenwich

16. Do you work for the Town of Greenwich?*

    1. No
    2. I am a Town of Greenwich Employee (non-BOE)
    3. I am a Greenwich BOE Employee

18. Have you ever worked at the polls in CT before?

    1. Yes
    2. No

19. If yes, when, where and in what position were you a poll worker.

21. Location Preferences

    Please indicate all the polling locations you are interested in working at.

    1. 1 - Julian Curtis School
    2. 2 - Greenwich Town Hall
    3. 3 - Western Middle School
    4. 4 - New Lebanon School
    5. 5 - Riverside School
    6. 6 - Old Greenwich School

    1. 7 - Greenwich High School
    2. 8 - Central Middle School
    3. 9 - Bendheim Western Greenwich Civic Center
    4. 10 - Glenville School
    5. 11 - North Street School
    6. 12 - North Mianus School
Leave This Blank:


22. 1. Receive email copy
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field