Kansas Voter Registration Application

In the case of wanting to register for voting in the State of Kansas, the following form has to be completed and submitted.

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Kansas Voter Registration Instructions	For further information, contact the Office of the Secretary of State, 1-800-262-VOTE (8683) V/TTY. This form is available at www.sos.ks.gov.	
 You can use this application to: 
• 	register to vote in Kansas	• 	change your name, address, or affiliation with a political party	
 To register to vote, you must: 
• 	be a U.S. citizen and a resident of the state of Kansas.	• 	have reached the age of 18 years before the next election.	• 	have received final discharge from imprisonment, parole, or condi	-	tional release if convicted of a felony.	• 	have abandoned your former residence and/or name.	
 How to register to vote: 
• 	Return your completed application to your county. Addresses are on the back of this application. Your county election officer will mail you a notice when your application has been processed.	• 	Voter registration closes 21 days before any election. In order to be eligible to vote in that election, your application must be postmarked on or before that date.	• 	If you decline to register to vote, that fact will remain confidential and will be used for voter registration purposes only. If you do register to vote, the office where you apply will be kept confidential and will be used for voter registration purposes only.	• 	If this form is incomplete, it may be rejected.	
 Identification number requirements 
Enter your current Kansas driver’s license number or nondriver’s identifica	-	tion card number. If you do not have either one, enter the last four digits of your Social Security number. If you do not have any of these numbers, write “none” in the box. The number will be used for administrative pur	-	poses only and will not be disclosed to the public. 	K.S.A. 25-2309	
 Proof of U.S. citizenship 
If you are registering for the first time in Kansas, you must submit proof of United States citizenship. You may provide a copy on paper or electronically, or you may show the document to an election officer or official registrar. The following is a partial list of acceptable documents:• 	Birth certificate that verifies U.S. citizenship	• 	U.S. passport (may be expired)	• 	U.S. naturalization documents or the number of the certificate of naturalization	• 	Bureau of Indian Affairs card number, tribal treaty number or tribal enrollment number	• 	U.S. hospital record of birth indicating place of birth in the U.S.	• 	U.S. military record of service showing the applicant’s name and U.S. birthplace	
 	For a list of acceptable documents, visit 	http://www.gotvoterid.com	. If you do not have any 	 of the documents, you may appeal to the state election board.	
Rev. 5/3/16 tc	
Kansas Voter Registration Application	Warning: If you submit a false voter registration application, you may be convicted and sentenced to up to 17 months in prison.	
Qualifications: 	If you mark “no” in response to either Question 1 or 2, do 	not	 complete this form.	
1. Are you a citizen of the United States of America?   	○	 Ye s	 ○	 No    	
2. Will you be 18 years of age on or before Election Day?  	○	 Ye s	 ○	 No	
Last Name (please print)	First Name	Middle	Jr. Sr. II III	○ Male	 	○ Female	
Residential Address (include apt. or space number)	City	County	Zip	
Mailing Address (if different than residential address)	City	Zip	Date Residence Established (MM/DD/YY)	
Birth Date (MM/DD/YY)	Daytime Phone Number (if available)	Naturalization Number (if applicable)	Driver’s License Number or Last 4 Social Security (see instructions)	
Party Affiliation:	 Choose one of the following:	 ○ Democratic	 ○ Republican	 ○ Libertarian	 ○ Not affiliated with a party	
Complete if previously registered (please print)	
Previous Name	Previous Residential Address (Street, City, State, Zip, County)	
Signature:	 I swear or affirm that I am a citizen of the United States and a Kansas resident, that I will be 18 years old before the next election, that if convicted of a felony , I 	have had my civil rights restored, that I have abandoned my former residence and/or other name, and that I have told the truth on this application.
Signature	Date (MM/DD/YY)	
For office use only: 	Ward ______________________ Pct. ______________________ School Dist. ______________________ Member Dist. ______________________	
Sen. ________________ Rep. ________________ CoComm ________________ Section ________________ Township ________________ Range _________________	
Print in blue or black ink, fold on the center line, seal, and return.	
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