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Election Day 2010

If you believe your federal voting rights have been violated on Election Day 2010, please provide the following information. You may also submit this information by phone, mail, or by fax. We may contact you if the alleged activity appears to be covered by a federal voting law enforced by the United States Department of Justice and there are grounds for investigation.

First Name:  * Completion of this field is required
Last Name:  * Completion of this field is required
Street Address:
City:
State:
ZIP Code:
Phone Number:  (phone format: xxx-xxx-xxxx) * Completion of this field is required
E-mail Address:
Area of violation of Voting Rights - select at least one that applies
  Vote Denial - Race Vote Denial - Language
  Denial of Provisional Ballot (specify below) Voter ID
  Bilingual Voter Assistance (blind, disabled, illit.)
  Intimidation/Challenge Pollworker Conduct
  Machines - Malfunction Machines - No Disability Access
  Registration Problems Criminal - Race, Color, Religion, National Origin
  Criminal - Fraud, Other Voting by Military Personnel/Overseas Citizen
  Other Comment
Description of incident:
maximum 3000 characters
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