Student Poll Worker Application

Student Poll Worker Application

This application is only for the General Election on 11/05/2024.
Applications accepted on a rolling basis; apply ASAP.

THREE (3) SIGNATURES REQUIRED: Student, Principal, and Parent or Guardian.
TYPED SIGNATURES WILL RESULT IN A REJECTED APPLICATION.

Questions? Please email: involved17@phila.gov
Name*

First NameLast Name
Preferred Name
Pronouns
School*
Other School Write-in*
Date of Birth*

MonthDayYear
Date
Age you’ll be on Election Day (11/05/24):*
Address*
Phone*
Email*
example@example.com
Parent/Guardian Printed Name*
Submission Date*

MonthDayYear
Date
Zip Code*
Zipcode
Returning poll worker: I have worked at a polling place before and if it's possible would like to return to the same one. (optional):
As a student poll worker, I understand and agree that I am:*

By checking this box I understand that if I will be 18 on or before Election Day (11/5/24),I must be registered to vote in Philadelphia.By checking this box I certify that I am a resident of PhiladelphiaBy checking this box I certify that I am a US citizenAs a student poll worker, I understand and agree that I am:
- Becoming a member of the Precinct Election Board
- Committing to work from 6:30 AM to at least 8:30 PM on Election Day (11/5/2024)
- Acknowledging that I cannot show up late nor leave early
- May need to travel to any part of the city, even if it is not close to my residence
- Have an exemplary record as determined by my school
- Must attend virtual training, which is required
- Responsible for providing accurate and full information on the Election Day payroll sheet. I
  understand that failure to fill out the payroll sheet will result in non-payment
- Completing this application in full to ensure my eligibility for the Governor’s Civic Engagement Award.
- I have the option to upload a photo to the online application to be featured on the Department of
  State (DOS) website if I am recognized with Governor’s Civic Engagement Award. Uploading the
  photo authorizes DOS to use the photo.
I speak a secondary language fluently, and would like to serve as an interpreter.
Secondary Language
Click here to download a printable version of the application
I understand:

I understand that by choosing to be an interpreter, I may be asked to work in an area that has a need or vacancy, and may require travel.
File Upload

You must submit signatures from your guardian, teacher, and principal for your application to be complete. You can download the application above, print, and take a photo or scan it. Signatures can be uploaded here or emailed directly to involved17@phila.gov
Cancelof
Upload photo for Governor's Civic Engagement Award (optional):

Cancelof
Should be Empty: