Presiding Judge Acceptance
Presiding Judge Information for Precinct *    
 
*Party Affiliation:    
 
*Have you submitted this form before? 
 
      
*Last Name     *First Name    M.I.
 
*Residential Address (where you are registered to vote) 
 
Mailing Address (if different from above)
 
      
*City *State*Zip Code 
 
E-Mail Address
 
*Home Phone Number 
 
Cell Phone Number
 
Other Phone Number
 
*Please Check One of the Following
 
If you Checked "No", who will be able to serve in your place?
      
Last Name First Name M.I.
 
Phone Number

Election Day Pollworker Information:

Names of 2 Clerks attending eSlate Training
You or your clerks must call our office at 713.755.5792 to
reserve training. This form will NOT reserve training for your clerks.
 
Names of 1st Clerk
      
Last Name First Name M.I.
 
            
Address City State Zip Phone
 
Names of 2nd Clerk
      
Last Name First Name M.I.
 
            
Address City State Zip Phone
 
Names of Spanish Speaking Clerk
      
Last Name First Name M.I.
 
            
Address City State Zip Phone
 
Names of Vietnamese Speaking Clerk
      
Last Name First Name M.I.
 
            
Address City State Zip Phone
 
Names of Chinese Speaking Clerk
      
Last Name First Name M.I.
 
            
Address City State Zip Phone
 
Comments
 
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 (*).