First Name: Last Name:
ND NetID: Email:
Primary Phone:
Voicemail:
Dorm: Alumni Hall Badin Breen-Phillips Hall Carroll Hall Cavanaugh Hall Dillon Hall Farley Hall Fisher Hall Howard Hall Keenan Hall Keough Hall Knott Hall Lewis Hall Lyons Hall Marilyn Keough Hall McGlinn Hall Morrissey Hall O'Neill Family Hall Pangborn Hall Pasquerilla East Pasquerilla West Siegfried Hall Sorin Hall St. Edward's Hall Stanford Hall Walsh Hall Welsh Family Hall Zahm Hall Off-Campus
Local Address:
City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip:

Voter Registration Information:
I am already registered to vote Yes No
I am not registered to vote, but would like help in learning how to get registered Yes No
I would like help requesting an absentee ballot Yes No
I would like to help mobilize others to vote Yes No

Hometown:
County (if known):
State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code:

University Affiliation: Undergraduate Student Graduate Student Faculty, Staff, Administration
Graduation Year:
College: Arts and Letters Architecture Business Engineering First Year of Studies Science Graduate School N/A
Gender: Female Male
Ethnicity:
Asian/Pacific Islander Yes No
Hispanic/Latino Yes No
Caucasian/Euro American Yes No
American Indian/Alaskan Native Yes No
Black/African American Yes No