Vot-ER Custom Materials

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Thank you for your interest in ordering Vot-ER materials for your institution or team! Upon filling out this form, you'll receive a custom, digital suite of resources designed to help you integrate voter registration into your daily practice. These digital resources are free of charge.

Step 1 of 3: Basic Information

First Name

Required

Last Name

Required

Email Address

Required

Phone Number

Required

Your Occupation

Required

Organization Name

Required

What group, team, department, etc. are you ordering for?

What state is your organization in?

Required

The majority of my patients are (select all that apply):

Required

The majority of my patients are (select all that apply):

24 years old or younger.

Medicaid/CHIP eligible or do not have health insurance.

Self-identified as Black/African American and/or Hispanic/Latino.

Best served in a language other than English.

None of the above apply

My institution views itself as a space that is designed to serve (select all that apply):

Required

My institution views itself as a space that is designed to serve (select all that apply):

LGBTQ+ communities

Rural communities.

Indigenous communities.

Individuals with physical, mental, and/or emotional disabilities.

None of the above apply

Which of the following best describes you?

Required

Which of the following best describes you?

I am a senior leader in my institution/department.

I have secured approval from my institution/department to use Vot-ER tools.

I am using Vot-ER tools in a way that doesn't require institutional sign-off

I am working to secure sign-off

Other