Third Party Voter Registration Drive Sworn Affidavit and Application Request

Completing this form provides the legally required sworn affidavit attesting that you will abide by all Virginia laws and rules regarding the registration of voters. Please be advised that intentionally falsifying or misrepresenting material information on this form is in violation of ยง 24.2-1016, shall constitute the crime of election fraud, and be punishable as a Class 5 felony.
 
This form is required if requesting 25 or more voter registration applications.

Tell us about yourself

I am *

This affidavit is for

Address (required if requesting voter registration applications)

Request Voter Registration Applications

I am requesting voter registration applications from the Department of Elections or a local Voter Registration Office for a voter registration drive (limit 200 applications): *

Sworn Affidavit

I have completed the Virginia Department of Elections certified training approved by the Virginia State Board of Elections. I understand this annual certification is valid until June 30th each year, at which time I must complete the training again in order to renew my certification. *
I will abide by all Virginia laws and rules regarding the registration of voters, including (Please check each to affirm): *
If I am acting on behalf of an organization, I will use my best efforts to ensure that this organization will abide by all Virginia laws and rules regarding the registration of voters, which will include additional training and supervision of individuals working on behalf of my organization. *
I understand that criminal penalties may result from noncompliance, intentionally falsifying, or misrepresenting material information. *
I swear or affirm under penalty of perjury that the foregoing is true and correct. *
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