Poll Manager Application

Poll Manager Application
Date Submitted: Date Submitted: / MM / DD YYYY
Are You A Student? *

Are You A Student? Yes No
Name of High School: *
I Am Currently: *

I Am Currently: Junior Senior
Name of 2 School Teachers and/or Administrators for Reference/Recommendation(Required)
1. *
2. *
Are You a Registered SC Voter? *

Are You a Registered SC Voter? Yes No
Voter Registration Number: *
County: *
Name Name * Title First Last Suffix
Street Address: Street Address: *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Different Mailing Address?

Different Mailing Address?
Mailing Address: Mailing Address:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone: *

Phone: Home Cell Other
Home Phone: Home Phone: * - ### - ### ####
Cell Phone: Cell Phone: * - ### - ### ####
Other Phone: Other Phone: * - ### - ### ####
Email Address: *

Confirm Email Address *
Date of Birth: Date of Birth: * / MM / DD YYYY
Occupation: *