Student Election Assistant Application

Student Information

Please provide required applicant information.
I am a citizen of the United States, a resident of Durham County, NC, at least 17-years old and enrolled in a secondary educational institution, including a home school, with an exemplary academic record as determined by that institution.*

Yes
Name*

First NameMiddle NameLast Name
Date of Birth *

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com

Select the position of the individual recommending you to serve as a Student Election Assistant. *
All information provided for the recommending official will be confirmed prior to application approval.
Enter your recommender's name: *

First NameLast Name
Name of your educational institution *
If you are homeschooled, enter "Homeschool".
Enter your recommender's phone number: *
Enter your recommender's email address *
example@example.com

Select the guardian type that will be authorizing you to work as a Student Election Assistant. *
All information provided for your listed guardian will be confirmed prior to application approval.
Enter your guardian's name: *

First NameLast Name
Enter your guardian's address*

Street Address

Street Address Line 2

CityState

Zip Code
Enter your guardian's phone number: *
Please enter a valid phone number.
Enter your guardian's email address *
example@example.com

Student Signature
By my signature, I confirm all of the provided information is accurate. *

Clear
Should be Empty:

Student Election Assistant Application (SEA)