Student Election Clerk Application and Permission Form
Name of Student _________________________________ Date of Birth _____________________
Home Address ___________________________________ Telephone Number ________________
School Attending _________________________________ Election Date ____________________
Student Affidavit: By signing this application, I acknowledge the following:
I am interested in working the following election(s) ____________________ (election date).
I am/will be at least 16 years of age on Election Day.
I am currently enrolled at _____________________________ (name of school).
I am a United States citizen.
I will complete the required training course prior to Election Day.
I agree to obtain an excused absence from my school office for Election Day. I will
promptly notify the election office if I am unable to obtain an excused absence. It is my
responsibility to collect and complete any and all school assignments for the day.
(signature of student)
__________________________________________
(date)
____________________
Parent/Legal Guardian Permission: This is to certify that I give permission for my son/daughter,
named above, to serve as a student election clerk for _____________________________(election).
(signature of parent/legal guardian)
_________________________________________
(date)
____________________
(print name)
_________________________________________
(telephone number)
____________________
School Principal Permission: This is to certify that the student named above is currently enrolled
at __________________________________ (name of school) and has my consent to serve as an
election clerk on _____________________ (date).
(signature of principal)
_________________________________________
(date)
____________________
(print name)
_________________________________________
(Home-schooled students must have the Parent/Legal Guardian Permission section completed by the parent/legal
guardian responsible for their education.)
Send the completed form to your local elections office conducting the election for which you wish
to serve (county clerk/elections administrator, city secretary, school superintendent, etc.). For more
information about elections, go to the Secretary of State’s website at www.sos.state.tx.us.
