LEAP Sign Up Form

Student LEAP Program Sign Up Form

For the Monroe County Board of Elections
Have you Registered or Pre-registered to Vote in Monroe County (required) *

Yes No
Full Name of Student (required) *

First Name Middle Initial Last Name Suffix (if app)
Full Name of Parent/Guardian (required) *

First Name Middle Initial Last Name Suffix (if app)
Student Contact Number (required) *
Parent/Guardian Number (if different)
Student E-mail (required) *
example@example.com
Parent/Guardian E-mail (if different)
example@example.com
Address (required) *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
How did you find out about being a poll worker? (Ex: Job fair, flyers, PSA, etc.)
I understand that in order to participate in the Student LEAP program I will need to return a signed Student LEAP Parent/Guardian Consent Form to the Monroe County Board of Elections at the time of Training (required) *

Yes
Link to LEAP Parent/Guardian Consent Form (open in new Window):

https://www.monroecounty.gov/files/boe/Poll%20Workers/2022%20LEAP%20Parent%20Consent%20Form%20Fillable.pdf
You must be Registered or Pre-registered to Vote in Monroe County to participate in the Student LEAP Program.

To check your Voter Registration Status click this Link: https://www.monroecounty.gov/etc/voter/

To Register to Vote Online follow this Link: https://www.ny.gov/services/register-vote

OR to download a Voter Registration Form and mail it in click here: https://www.monroecounty.gov/files/2021voteregform-eng-fillable.pdf
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Student LEAP Program Sign Up Form