Voting Accessibility Advisory Committee Application
The Placer County Voting Accessibility Advisory Committee will meet on a regular basis to discuss methods of improving voting accessibility and participation for older adults and persons with disabilities. Policy recommendations formulated at meetings will be reviewed by election officials and may be considered for adoption. All members are asked to remain on the committee for at least one (1) year from the date of the first meeting.
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First Name (required)

Middle Name

Last Name (required)

Residential Address (required)

City (required)

Zip (required)

Mailing Address (if different from residence)

City

Zip

Birth Date (required)

E-mail (required)

Cell Phone # (required)

Home/Other #

Organization Information (if applicable)
Name of Organization

Organization Type

Website Address

Organization Capacity

Service Provided

Estimated Membership Count

Meeting Frequency and Attendance

Email Address

Phone #

Are you a registered Placer County voter?
YesNo
Have you served on a VAAC before?
YesNo
If Yes, where:

Are you a Placer County employee?
YesNo
If Yes, which department:

Are you currently or intend to be a candidate for office, or a current officeholder?
YesNo
Are you willing to attend quarterly meetings in-person and/or virtually?
YesNo
Do you have experience with working on accessibility issues pertaining to disability rights?
YesNo
If Yes, please describe your relevant experience in the space below.

Do you have experience participating in an election or outreach in engaging community members?
YesNo
If Yes, please describe your relevant experience in the space below.

By submitting this application, I am affirming that I am formally applying for membership with the Voting Accessibility Advisory Committee for Placer County, and that I commit myself to being a member of the committee for at least one (1) year from the date of the first meeting I attend.

CONTACT US
For all questions and inquiries regarding the Voting Accessibility Advisory Committee, please contact us. We’d love to hear from you!
Phone: 530-886-5650 (toll-free in CA 1-800-824-8683)
Email: [email protected]

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