Residency Voting Registration Survey

Residency Voting Registration Survey
Register for residency-based voting and share your opinions about the voting process.
Full Name
First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Current Residential Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
How long have you lived at your current address?
Are you a resident eligible to vote in this jurisdiction?
What is your age group?
Preferred Voting Method
Other

Please rate your agreement with the following statements about residency-based voting:

Rows	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Residency-based voting increases community engagement.
Residency requirements for voting are fair.
I feel well-informed about my voting rights as a resident.

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