Presiding Judge Acceptance

*Presiding Judge Information for

*Party Affiliation?

Democratic Republican Non-Partisan

*Have you submitted this form before?

Yes No

*Last Name required minimum 2 characters

*First Name required minimum 2 characters

M.I.

*Address (where you are registered to vote) required minimum 2 characters

*City required minimum 2 characters

*State required

*Zip Code required invalid

Mailing Address (if different from above) minimum 2 characters

City minimum 2 characters

State

Zip Code invalid

*Email required invalid

*Home Phone required invalid

Mobile Phone invalid

Other invalid

*Please check one of the following
Yes, I will hold the
No, I will not be able to hold the

If you checked "No", who will be able to serve in your place?

Last Name minimum 2 characters

First Name minimum 2 characters

M.I.

Phone Number invalid

Election Day Worker Information

1st Clerk

Last Name minimum 2 characters

First Name minimum 2 characters

M.I.

Address minimum 2 characters

City minimum 2 characters

State

Zip Code Invalid

Phone invalid

2nd Clerk

Last Name minimum 2 characters

First Name minimum 2 characters

M.I.

Address minimum 2 characters

City minimum 2 characters

State

Zip Code invalid

Phone invalid

3rd Clerk (if allocated)

Last Name minimum 2 characters

First Name minimum 2 characters

M.I.

Address minimum 2 characters

City minimum 2 characters

State

Zip Code Invalid

Phone invalid

4th Clerk (if allocated)

Last Name minimum 2 characters

First Name minimum 2 characters

M.I.

Address minimum 2 characters

City minimum 2 characters

State

Zip Code Invalid

Phone invalid

5th Clerk (if allocated)

Last Name minimum 2 characters

First Name minimum 2 characters

M.I.

Address minimum 2 characters

City minimum 2 characters

State

Zip Code Invalid

Phone invalid

6th Clerk (if allocated)

Last Name minimum 2 characters

First Name minimum 2 characters

M.I.

Address minimum 2 characters

City minimum 2 characters

State

Zip Code Invalid

Phone invalid

Spanish Speaking Clerk

Last Name minimum 2 characters

First Name minimum 2 characters

M.I.

Address minimum 2 characters

City minimum 2 characters

State

Zip Code invalid

Phone invalid

Vietnamese Speaking Clerk

Last Name minimum 2 characters

First Name minimum 2 characters

M.I.

Address minimum 2 characters

City minimum 2 characters

State

Zip Code invalid

Phone invalid

Chinese Speaking Clerk

Last Name minimum 2 characters

First Name minimum 2 characters

M.I.

Address minimum 2 characters

City minimum 2 characters

State

Zip Code invalid

Phone invalid

Comments
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Please remember to call our office if you are unable to locate and place a clerk who speaks Spanish, Vietnamese, or Chinese ASAP. All of your clerks must be registered voters of Harris County.

Please make sure that you complete all fields that are preceded by a (*).