Online Voter Registration

Online Voter Registration Application:

If you are an existing WIC participant with a valid password provided at your most recent WIC appointment, please enter your WIC Family ID and Password before proceeding. Otherwise, please click NEXT to begin your online voter registration application.

WIC Family ID:

Password:

Click RETRY to re-enter your WIC provided information, or press NEXT to begin your online voter registration application.

RETRY login information NEXT

All fields are required unless marked as optional.

Your Name:

First Name:

Middle Name or Initial (optional):

Last Name:

Suffix (optional):
II III IV JR SR V VI VII I

Eligibility:

If you answer NO to either question, you CANNOT register to vote.

To register, you must:

• Be a United States citizen at least 30 days before the next election
• Be a resident of Pennsylvania and your election district for at least 30 days before the next election
• Be at least 18 years of age on the day of the next election

Reason:

If you are currently registered to vote, you do not have to use this application unless you have moved or changed your name.
NOTE: If you have recently moved to Pennsylvania from another state, you must submit a new application rather than a change of address.

About You:

Birth Date (mm/dd/yyyy):

Race (optional):
ASIAN BLACK OR AFRICAN AMERICAN HISPANIC OR LATINO NATIVE AMERICAN OR ALASKAN NATIVE NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER OTHER TWO OR MORE RACES WHITE

Phone (optional):

Email Address (optional):

Your Residence Address:

Enter the address of your residence. You may not use a P.O. Box address.

I do not have a street address or permanent residence.

If you live in a rural area or are homeless and do not have a street address or a permanent residence,   print out and complete this Voter Registration Application , use the map on the printed form to show where you live or spend most of your time, and mail it to your county voter registration office.

Street Address:

Street Address 2:

Unit Type (if applicable):
APARTMENT BASEMENT BOX # BUILDING DEPARTMENT FLOOR FRONT HANGER LOBBY LOT LOWER OFFICE PENTHOUSE PIER POLL REAR ROOM SIDE SLIP SPACE STOP SUITE TRAILER UNIT UPPER TRAILER CABIN HUB STUDENT MAILING CENTER TOWNHOUSE

Unit Number (if applicable):

City:

State:
PA

Zip Code:

County:
Select a county ADAMS ALLEGHENY ARMSTRONG BEAVER BEDFORD BERKS BLAIR BRADFORD BUCKS BUTLER CAMBRIA CAMERON CARBON CENTRE CHESTER CLARION CLEARFIELD CLINTON COLUMBIA CRAWFORD CUMBERLAND DAUPHIN DELAWARE ELK ERIE FAYETTE FOREST FRANKLIN FULTON GREENE HUNTINGDON INDIANA JEFFERSON JUNIATA LACKAWANNA LANCASTER LAWRENCE LEBANON LEHIGH LUZERNE LYCOMING MCKEAN MERCER MIFFLIN MONROE MONTGOMERY MONTOUR NORTHAMPTON NORTHUMBERLAND PERRY PHILADELPHIA PIKE POTTER SCHUYLKILL SNYDER SOMERSET SULLIVAN SUSQUEHANNA TIOGA UNION VENANGO WARREN WASHINGTON WAYNE WESTMORELAND WYOMING YORK

Municipality (optional):

Your Mailing Address:

Check here if your mailing address is the same as your residence address above.

Mailing Address:

Mailing City:

Mailing State:

Mailing Zip Code:

Identification:

The Department of State will mail a signature capture letter for you to sign and return when identification for options one and two is not provided or fails validation, the electronic signature fails to meet minimum quality standards, or you are unable to provide an electronic signature.

Option 1.If you have a PA driver's license or PennDOT ID card number, you must enter your PennDOT number and sign your name in the signature field provided in this section.

Option 2. If you do not have a PennDOT number, please enter the last 4 digits of your Social Security number and sign your name in the signature field provided in this section.

Option 3. If you do not have a PA driver's license or PennDOT ID card or a Social Security number, please check the box and sign your name in the signature field provided in this section.

Political Party:

To vote in a primary, you must register with either the Democratic or Republican party.

Voting Assistance:

(Optional) If you require assistance with voting, please complete this section.

Type of Assistance needed: I am deaf or hard of hearing I am blind or have difficulty seeing I use a wheelchair I have a physical disability I need help reading I do not speak English well

My Preferred Language:

Declaration:

WARNING: If a person signs an official registration application knowing a statement declared in the application to be false, makes a false registration, or furnishes false information, the person commits perjury. Perjury is punishable, upon conviction, by a term of imprisonment not exceeding seven years, or a fine not exceeding $15,000, or both, at the discretion of the court. Submitting an application containing false information may also subject a person to other penalties, including loss of the right of suffrage, under state or federal law.

Help with this Form:

If you assisted in the completion of this application, please enter the following information.

Name:

Address:

Phone Number:

If you helped a voter complete this voter registration application, you must also sign the application.

• You understand that your electronic signature on this application will constitute the legal equivalent of your signature.
• You agree to sign this application by electronic means and that all laws of the Commonwealth of Pennsylvania will apply.

Be a Poll Worker:

(Optional) If you select 'Yes' for either of these statements, your county voter registration office will contact you.

I speak this language:

SUBMIT votor registration information RESET the form