SANTA CRUZ COUNTY ELECTIONS
VOTER COMMENT, CONCERN and COMPLAINT FORM

This form is provided to register with the Santa Cruz County Elections Department your comment, complaint and/or concern regarding an election process or procedure. Your name and contact information will be confidential but the text of the complaint/concern may be used in training or appear in the media for voter education. All the fields are optional. Thank you.

1. Your Name:

What's the best way to contact you?
Email     Telephone     No Contact Desired

2. Phone (Optional) 3. Email Address: (Optional)
4 Address of the voting place (or nearby intersection)
 		5. Precinct Number: (If known)
5. Name of Precinct Worker (If known)

 

6. VOTER COMMENT, CONCERN or COMPLAINT: