V

RO .O

SJC

RG
(209) 468-2892

LEARN WHILE
YOU EARN
ARE YOU IN HIGH SCHOOL?
BE A POLL WORKER!
YOU GET TO
Help carry out the most important event in
our democracy - an election
Earn $200 for your day of service and $35
for mandatory online training while you
learn about elections
Contribute to your community
YOU HAVE TO
Be a United States citizen or legal
permanent resident
Be at least 16 years old on Election Day
Attend a public or private high school
Have at least a 2.5 GPA
Get permission from your parents & school

TER T
DID YOU KNOW?
High school students are entitled to one excused
IS
absence per year to attend a civic or political
O
E-REG

VOTE

event such as poll working.

AT 16 OR 17
PR

REGISTERTOVOTE.CA.GOV
 STUDENT ELECTION OFFICER PROGRAM APPLICATION
SAN JOAQUIN COUNTY REGISTRAR OF VOTERS OFFICE
(Please print clearly and complete entire form)

Full Name: (First, Middle, Last) Fluent in another language? (If yes, please specify)
Arpit Uppal Yes, Hindi/Punjabi
Home Address: Mailing Address:
263 E Grazia Ave 263 Grazia Ave
City: Zip Code: City: Zip Code:
Mountain House 95391 Mountain House 95391
Student Personal Email:
(Print Clearly) uarpit@hotmail.com
STUDENT

Home Phone Cell Phone HIGH SCHOOL ATTENDING

(518) 368-9694 (209) 597-7605 Mountain House
Date of Birth: Social Security #:(Required for payroll) High School
________________________
April 8, 2007
I understand that I must meet the following requirements to be eligible for this program:
* A high school student with a 2.5 GPA
* A United States citizen or lawful permanent resident
* At least 16 years old on or before Election Day

1/3/2024
Student Signature: ___________________________________________ Date: __________________
Print Parent/Guardian Name: Emergency Phone Number(s) on Election Day:
Suresh Uppal (510) 701-8153
PARENT

I have read the parent information letter and give permission for my student, named above, to serve as a
Student Election Officer.
1/15/24
Parent Signature: __________________________________________ Date: ____________________

Teacher/Administrator: High School:

Francis Estabillo Mountain House High School
SCHOOL

As a teacher/administrator at the above-mentioned high school, I verified that the above-named student
meets the eligibility requirements.

Francis Estabillo
Teacher/Administrator Signature: _____________________________ 1/16/24
Date: ____________________

By Fax: (209) 468 -9534 By Email: students@sjgov.org

RETURN

In Person: 44 N. San Joaquin St., Suite 350, Stockton, CA 95202

FOR ROV USE ONLY

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REV 4/2023