National Voter Registration Act Implementation

If Americans with disabilities vote at the same rate as people without disabilities there would be at least five million additional votes cast November 7, 2000. A major reason for the failure of most Americans with disabilities to vote is they are not registered to vote. With Rights Come Responsibilities.

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National Voter Registration Act
Implementation Questionnaire Form

Agency Name: _________________________________________________________

Agency Address: ________________________________________________________

_________________________________________________________________

Agency Phone: ______________________ Contact Person: _____________________

Date: ____________

Questions:

1) Does your agency offer the opportunity to register to vote to your clients as part of intake?
________ YES __________ NO

2) Does your agency offer the opportunity to register to vote to your clients as they receive services from your agency?
_______ YES __________ NO

3) Does your agency keep records of those clients who decline to register to vote?
________ YES __________ NO

4) Who in your agency is in charge of ensuring that your agency complies with the National Voter Registration Act?

________________________________________


Name of surveyor: ____________________________

Address: _________________________________

_________________________________


Phone Number: _____________________

Please return this information to:
Jim Dickson
V.P. of Governmental Affairs
AAPD Disability Vote Project
1629 K Street, NW, Suite 503
Washington, DC 20006
V/TTY: 202-457-0046
V/TTY: 800-840-8844
FAX: 202-457-0473
AAPD Website

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