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NORTH CAROLINA VOTER REGISTRATION APPLICATION (fields in red are required) NCSBOE 2018.04
1 Indicate whether you are qualified to vote or preregister to vote based on U.S. citizenship and age.
Are you at least 16 years of age and understand that you must be 18 years of age on or before election day to vote? Yes No
IF YOU CHECKED ‘”NO” IN RESPONSE TO BOTH OF THESE AGE QUESTIONS, DO NOT SUBMIT THIS FORM. YOU ARE NOT QUALIFIED TO REGISTER OR PREREGISTER TO VOTE.
Provide your full legal name. Provide your date of birth and identification information.
2 (last name, first name and middle name) 3
Legal Last Name Suffix Date of Birth (MM/DD/YYYY) State or Country of Birth
/ /
Legal First Name NC Driver License or NC DMV ID Number Last Four Digits of Social Security Number
Middle Name Check if you do not have a driver State Voter Registration Number - Optional
license or Social Security number. (To locate, check “Voter Lookup” at www.NCSBE.gov.)
Provide your residential address - where you physically live. Provide a mailing address if you do not receive mail at your residential address.
4 (Do not enter a P.O. Box or a mail drop location. Your address determines your voting districts) 5
Address Number Street Name and Type Mailing Address Line 1
Address Line 2 (e.g., apartment, lot or unit number) Mailing Address Line 2
County Have you lived at this address If “No”, date moved? City State Zip code
for 30 or more days?
Yes No
No Physical Address?
If you do not have an address, use the space to the right to
illustrate where you normally live or sleep. Write in the names
of the nearest crossroads (or streets). Draw an X on the map
to show where you live or usually sleep.
Provide your demographic information (optional). Provide your choice for political party affiliation.
6 7
Political Party Preference
Hispanic/Latino
Gender Male Female Ethnicity Democratic Party Republican Party
Not Hispanic/Latino
Green Party No party affiliation or Unaffiliated
African American/Black American Indian/Alaska Native Asian Libertarian Party Other ___________________________
Race
Multiracial Native Hawaiian/Pacific Islander White Other If you enter a party that is not recognized in North Carolina, you will be registered as Unaffiliated.
Complete if you are currently registered to vote in another NC county or in another state.
8 (This information will be used to cancel your previous voter registration in the other county or state.)
First Name Used in Last Registration Middle Name Used in Last Registration Last Name Used in Last Registration Suffix
Address Where You Were Last Registered City/State/Zip Code of Last Registration County of Last Registration
X
Signature Date
NORTH CAROLINA VOTER REGISTRATION APPLICATION INSTRUCTIONS
You may use this application to do any of the following: Registration Deadline
Register to vote To be effective for an upcoming election, this application must be
Preregister to vote if between the ages of 16 and 17 received by your county board of elections office no later than 25
Change party affiliation or unaffiliated status days before the date of the election. If mailed, the application
Report a change of address within a county may be received later than the deadline if it is postmarked on or
Report a name change. before the deadline.
Same Day Registration: If you miss the voter registration
To qualify to vote:
deadline, you may register and vote during the one-stop
You must be a citizen of the United States absentee voting period (early voting) for the election. You must
You must be at least 18 years of age, or you will be 18 years complete a voter registration application in person at a one-stop
of age by the next general election and you are voting in the site in your county of residence and show proof of your current
primary, or residential address to an election official at the one-stop site.
You must be between the ages of 16 or 17 and desire to Acceptable proof of residence documents include a NC drivers
preregister to vote license or other photo ID issued by a government agency or a
You must have resided in North Carolina and in the precinct current utility bill, bank statement, government check, paycheck
in which you present to vote for at least 30 days prior to the or other government document that shows your name and
election address.
You must not be currently serving a felony sentence. If If you are not registered to vote by election day, you will not be
previously convicted of a felony, you must have fully eligible to vote in the election.
completed your sentence, including probation and/or parole.
No special document is required.
This form should be mailed, faxed, emailed or delivered in person to your county board of elections.
You may also mail the form to:
For more information concerning voter registration and voting requirements, contact the State Board at:
1-866-522-4723 (phone) or elections.sboe@ncsbe.gov (email).
www.NCSBE.gov