DO YOU NEED A RIDE TO VOTE? VOTE FOR HOMES! ... Polling Site Location/Where does the voter need to go? ... You can also
DO YOU NEED A RIDE TO VOTE? VOTE FOR HOMES! Election Day Transportation Ride Request Form For more information, call Vote for Homes at 215-232-7272, x3061, x3042 or x3106. 1. Name of Voter: __________________________________________________________ 2. Phone Number: __________________________________________________________ 3. Pick-up Location: Address: _____________________________________________________________________ Name of Program or Shelter (if applicable):_________________________________________ Onsite Contact Person’s Name:___________________________________________________ Onsite Contact Person’s Phone Number:____________________________________________ 4. Time of Pick-Up (Select a time between 10:30am-7pm): __________________________________ 5. Special Transportation Needs: Wheelchair: Y/N Walker: Y/N Does voter need accessible van? Y/N Children: Y/N
List Ages: _____________________________
Other needs? _____________________________ 6. Polling Site Location/Where does the voter need to go? Visit www.bit.ly/VoteVerifyPA (or google “SURE PORTAL” for more information) or call 215-686-1523 Polling Site Location:____________________________________ Polling Site Address:____________________________________ Ward: ______
Division: _______
7. Date of Birth: ____________________________ (This is a MUST if we do not have their polling location on the call sheet. It is useful for everyone so we can find verify the voter’s most current polling location.) Note to Program Managers: Please photocopy this form and announce to residents or pass around at a community meeting. We can pre-schedule a limited number of rides. For best results, return this form by fax to 215-232-7277 to Vote for Homes! by Monday, November 3, 2014 at 3 pm. You can also call 215-232-7272 or fax the information on Election Day and we will do our best to accommodate you.
www.voteforhomes.org
FOR OFFICE USE ONLY: Entered in VAN? __________ Initials __________ VAN ID OF VOTER________________________________
