KCD Entered PCO Forms

Please complete the following form to recommend a member of your legislative district for the role of Appointed or Acting PCO.
Applicant's Full Name (As it appears on their voter registration)*
First Name Last Name
Applicant's Preferred Name
First
Applicant's Legislative District*
Applicant's Assigned Precinct*
Residential Precinct for Appointed PCOs, Service Precinct for Acting PCOs Use long form precinct name: XXX DD-XXXX or NAME
Applicant's VAN ID*
2020 Dem Party Support Score
2020 National Turnout Score
Is the applicant registered to vote?*
- Yes
- No
Which PCO role is the applicant approved for?*
- Appointed
- Acting
Date of General Meeting Approval:*
Date Format: MM slash DD slash YYYY
Applicant's Contact Information
Address (As it appears on the applicant's voter registration)*
Street Address Address Line 2 City State ZIP Code
Is the applicant's address the same as their mailing address?*
- Yes
- No
Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Applicant's Email*
Applicant's Phone*
Type of Phone
- Cell Phone
- Home Phone
Link to PDF of scanned document w/ LD Chair signature*
Name of person completing this form*
First Name Last Name
KCD Notes
Your Email
Optional if you want a copy of email to applicant
Your Role*
Date*
Date Format: MM slash DD slash YYYY
Confirm you're a real person.*
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Applicant's Contact Information