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Disability Complaint Form
Your complaint form has been submitted.
Disability Complaint Form
* Last Name
* First Name
M.I.
* Address
* City
* State
* Zip Code
* Email
* Phone Number
* This is being filled out by
-- Select one --
Self
Someone on behalf of the voter
HC Election Judge, Election Worker, or Staff
* Election
June 28, 2022 - Precinct Chairman Runoff
June 18, 2022 - Joint Runoff Election
May 24, 2022 - Primary Runoff Election
May 07, 2022 - Local and Constitutional Amendment Election
* Poll Location
-- Select one --
* Date of visit to the Poll
* What challenges or discrimination did you encounter voting at the above referenced polling location?
Issues with accessible parking
Issues with getting into the polling place or getting to the voting area (accessibility of polling location)
Issues with accessible voting station or machine
Issues with curbside voting
Issues with obtaining assistance by a person of the voter's choice
Inability to vote independently or privately
Issues with effective communication or auxiliary aids or services
Issues with election judge, election workers, Harris County employees, or other staff
Other
* Please describe these challenges or issues in more detail:
(Characters:
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/2000)
Please list the names and contact information (phone number, e-mail address, etc.) of any witnesses. If applicable, please also include their relationship to you.
(Characters:
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/2000)
Did you speak to any election judges, poll workers, or employees at the poll about the challenges you encountered? If so, please list their name(s) if you know it (them).
(Characters:
0
/2000)
What, if any, accommodations were made to address the challenges you encountered at the polling location?
(Characters:
0
/2000)
What accommodation or changes would you suggest be made at this polling location?
(Characters:
0
/2000)
Do you have any other comments or suggestions related to your voting experience?
(Characters:
0
/2000)
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