Ballot Drop-Off Schedule Request Form
Request an appointment to drop off your ballot at your selected location. Please provide your contact details and preferred time window.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Ballot Drop-Off Location
*
Please Select
Downtown Community Center
Eastside Library
Northside Recreation Hall
West End Civic Center
Other
Preferred Drop-Off Date and Time Window
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Alternate Drop-Off Date and Time Window
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Number of Ballots Being Dropped Off
*
Do you require accessibility accommodations or assistance at the drop-off location?
*
No, I do not require assistance
Yes, wheelchair access needed
Yes, language interpretation needed
Yes, other assistance (please specify below)
If you selected 'other assistance', please specify your needs
Notes or Special Instructions for the Election Office
Submit Request
Should be Empty: