2. Precinct*
3. Election Date:*
   Election Date:
5. Name:*
7. Do you anticipate being a Judge for the next election?

   1. Yes
   2. No
8. Would you be interested in having high school students work on your board?

   1. Yes
   2. No
10. Are you registered and able to vote in the precinct in which you work?

    1. Yes
    2. No
11. Were you able to set up the machines in a private manner?

    1. Yes
    2. No
13. If No, please explain:
15. Do you need help setting up your voting machines?

    1. Yes
    2. No
16. Did you have a problem getting into the polling location?

    1. Yes
    2. No
18. If so, how was it resolved and at what time did you open?
20. Are lines an issue in your precinct on Election Day?

    1. Yes
    2. No
21. If so is this something that needs addressed?

    1. Yes
    2. No
23. Do you have any suggestions on how to resolve?
25. Did you call the courthouse to verify any voters?

    1. Yes
    2. No
27. What machine errors did you encounter?
29. Were the errors corrected by a phone call to the courthouse of by a technician in the field?

    1. Yes
    2. No
31. When do you check the supplies, PEB's, Poll Books, etc.?
33. When do you contact your Election Board Members (select all that apply):

    1. <1 week before Election
    2. 2-4 weeks before election
    3. 4+ weeks before election
35. Do you have/need any additional names for new board members?

    1. Yes
    2. No
37. List new board member name(s) if applicable:
39. Did you have any problems with watchers in your precinct?

    1. Yes
    2. No
40. Did any voters have a hard time locating the entrance to your polling location?

    1. Yes
    2. No
42. Do you have any changes to address, phone number, and Election Board members?

    1. Yes
    2. No
44. List any address, phone number or board member changes here:
46. Please provide a phone number that we can call you on Election Day in case we need to contact you at the polling locations for any reason. PLEASE remember to TURN ON this phone and have it readily available!
48. Please place any questions, comments or concerns here:
Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit

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