NON-ROUTINE VOTERS, PART 1: Request for Assistance form

This is an example of a Request for Assistance form, which you will use for voters needing assistance.

In total, 3 people must mark this form:

1. An election officer should write the precinct name and date at the top of the form.
2. The voter must sign and print their name in Section A.
3. The assistant must sign and print their name and address in Section B.