Mobile Voter Outreach Van Request Form
Pinal Countyโ€™s Mobile Voter Outreach van is the first-of-its-kind in Arizona. It will help reach voters in rural parts of the county. To request the Voter Van at an event fill out the form below. Please allow 2-4 business days to receive a response.

*Please note that filling out this form does not confirm the Mobile Voter Outreach Van will be at your event, our attendance at your event is contingent on availability and/or compatibility of event purpose/goal. The Mobile Voter Outreach Van needs to follow polling place guidelines & procedures. Pinal County has the right to refuse attendance*

*Due to the COVID-19 pandemic we may not be able to accommodate all events and hours of availability may be restricted*


๐˜“๐˜ข ๐˜ค๐˜ข๐˜ฎ๐˜ช๐˜ฐ๐˜ฏ๐˜ฆ๐˜ต๐˜ข ๐˜ฅ๐˜ฆ ๐˜๐˜ฐ๐˜ต๐˜ข๐˜ฏ๐˜ต๐˜ฆ๐˜ด ๐˜ฅ๐˜ฆ๐˜ญ ๐˜Š๐˜ฐ๐˜ฏ๐˜ฅ๐˜ข๐˜ฅ๐˜ฐ ๐˜ฅ๐˜ฆ ๐˜—๐˜ช๐˜ฏ๐˜ข๐˜ญ ๐˜ฆ๐˜ด ๐˜ญ๐˜ข ๐˜ฑ๐˜ณ๐˜ช๐˜ฎ๐˜ฆ๐˜ณ๐˜ข ๐˜ฅ๐˜ฆ ๐˜ด๐˜ถ ๐˜ต๐˜ช๐˜ฑ๐˜ฐ ๐˜ฆ๐˜ฏ ๐˜ˆ๐˜ณ๐˜ช๐˜ป๐˜ฐ๐˜ฏ๐˜ข. ๐˜ˆ๐˜บ๐˜ถ๐˜ฅ๐˜ข๐˜ณรก ๐˜ข ๐˜ญ๐˜ญ๐˜ฆ๐˜จ๐˜ข๐˜ณ ๐˜ข ๐˜ญ๐˜ฐ๐˜ด ๐˜ท๐˜ฐ๐˜ต๐˜ข๐˜ฏ๐˜ต๐˜ฆ๐˜ด ๐˜ฆ๐˜ฏ ๐˜ญ๐˜ข๐˜ด ๐˜ป๐˜ฐ๐˜ฏ๐˜ข๐˜ด ๐˜ณ๐˜ถ๐˜ณ๐˜ข๐˜ญ๐˜ฆ๐˜ด ๐˜ฅ๐˜ฆ๐˜ญ ๐˜ค๐˜ฐ๐˜ฏ๐˜ฅ๐˜ข๐˜ฅ๐˜ฐ. ๐˜—๐˜ข๐˜ณ๐˜ข ๐˜ด๐˜ฐ๐˜ญ๐˜ช๐˜ค๐˜ช๐˜ต๐˜ข๐˜ณ ๐˜ค๐˜ฐ๐˜ฎ๐˜ฑ๐˜ญ๐˜ฆ๐˜ต๐˜ฆ ๐˜ฆ๐˜ญ ๐˜ง๐˜ฐ๐˜ณ๐˜ฎ๐˜ถ๐˜ญ๐˜ข๐˜ณ๐˜ช๐˜ฐ ๐˜ข ๐˜ค๐˜ฐ๐˜ฏ๐˜ต๐˜ช๐˜ฏ๐˜ถ๐˜ข๐˜ค๐˜ชรณ๐˜ฏ. ๐˜Œ๐˜ด๐˜ฑ๐˜ฆ๐˜ณ๐˜ฆ ๐˜ฆ๐˜ฏ๐˜ต๐˜ณ๐˜ฆ 2 ๐˜บ 4 ๐˜ฅรญ๐˜ข๐˜ด ๐˜ฉรก๐˜ฃ๐˜ช๐˜ญ๐˜ฆ๐˜ด ๐˜ฑ๐˜ข๐˜ณ๐˜ข ๐˜ณ๐˜ฆ๐˜ค๐˜ช๐˜ฃ๐˜ช๐˜ณ ๐˜ถ๐˜ฏ๐˜ข ๐˜ณ๐˜ฆ๐˜ด๐˜ฑ๐˜ถ๐˜ฆ๐˜ด๐˜ต๐˜ข.

* ๐˜›๐˜ฆ๐˜ฏ๐˜จ๐˜ข ๐˜ฆ๐˜ฏ ๐˜ค๐˜ถ๐˜ฆ๐˜ฏ๐˜ต๐˜ข ๐˜ฒ๐˜ถ๐˜ฆ ๐˜ค๐˜ฐ๐˜ฎ๐˜ฑ๐˜ญ๐˜ฆ๐˜ต๐˜ข๐˜ณ ๐˜ฆ๐˜ด๐˜ต๐˜ฆ ๐˜ง๐˜ฐ๐˜ณ๐˜ฎ๐˜ถ๐˜ญ๐˜ข๐˜ณ๐˜ช๐˜ฐ ๐˜ฏ๐˜ฐ ๐˜ค๐˜ฐ๐˜ฏ๐˜ง๐˜ช๐˜ณ๐˜ฎ๐˜ข ๐˜ฒ๐˜ถ๐˜ฆ ๐˜ญ๐˜ข ๐˜ค๐˜ข๐˜ฎ๐˜ช๐˜ฐ๐˜ฏ๐˜ฆ๐˜ต๐˜ข ๐˜ฅ๐˜ฆ ๐˜๐˜ฐ๐˜ต๐˜ข๐˜ฏ๐˜ต๐˜ฆ๐˜ด ๐˜ฅ๐˜ฆ๐˜ญ ๐˜Š๐˜ฐ๐˜ฏ๐˜ฅ๐˜ข๐˜ฅ๐˜ฐ ๐˜ฅ๐˜ฆ ๐˜—๐˜ช๐˜ฏ๐˜ข๐˜ญ ๐˜ฆ๐˜ด๐˜ต๐˜ข๐˜ณรก ๐˜ฆ๐˜ฏ ๐˜ด๐˜ถ ๐˜ฆ๐˜ท๐˜ฆ๐˜ฏ๐˜ต๐˜ฐ, ๐˜ฏ๐˜ถ๐˜ฆ๐˜ด๐˜ต๐˜ณ๐˜ข ๐˜ข๐˜ด๐˜ช๐˜ด๐˜ต๐˜ฆ๐˜ฏ๐˜ค๐˜ช๐˜ข ๐˜ข ๐˜ด๐˜ถ ๐˜ฆ๐˜ท๐˜ฆ๐˜ฏ๐˜ต๐˜ฐ ๐˜ฅ๐˜ฆ๐˜ฑ๐˜ฆ๐˜ฏ๐˜ฅ๐˜ฆ ๐˜ฅ๐˜ฆ ๐˜ญ๐˜ข ๐˜ฅ๐˜ช๐˜ด๐˜ฑ๐˜ฐ๐˜ฏ๐˜ช๐˜ฃ๐˜ช๐˜ญ๐˜ช๐˜ฅ๐˜ข๐˜ฅ ๐˜บ / ๐˜ฐ ๐˜ค๐˜ฐ๐˜ฎ๐˜ฑ๐˜ข๐˜ต๐˜ช๐˜ฃ๐˜ช๐˜ญ๐˜ช๐˜ฅ๐˜ข๐˜ฅ ๐˜ฅ๐˜ฆ๐˜ญ ๐˜ฑ๐˜ณ๐˜ฐ๐˜ฑรณ๐˜ด๐˜ช๐˜ต๐˜ฐ / ๐˜ฐ๐˜ฃ๐˜ซ๐˜ฆ๐˜ต๐˜ช๐˜ท๐˜ฐ ๐˜ฅ๐˜ฆ๐˜ญ ๐˜ฆ๐˜ท๐˜ฆ๐˜ฏ๐˜ต๐˜ฐ. ๐˜“๐˜ข ๐˜ค๐˜ข๐˜ฎ๐˜ช๐˜ฐ๐˜ฏ๐˜ฆ๐˜ต๐˜ข ๐˜ฅ๐˜ฆ๐˜ฃ๐˜ฆ ๐˜ด๐˜ฆ๐˜จ๐˜ถ๐˜ช๐˜ณ ๐˜ญ๐˜ข๐˜ด ๐˜ฑ๐˜ข๐˜ถ๐˜ต๐˜ข๐˜ด ๐˜บ ๐˜ญ๐˜ฐ๐˜ด ๐˜ฑ๐˜ณ๐˜ฐ๐˜ค๐˜ฆ๐˜ฅ๐˜ช๐˜ฎ๐˜ช๐˜ฆ๐˜ฏ๐˜ต๐˜ฐ๐˜ด ๐˜ฅ๐˜ฆ๐˜ญ ๐˜ญ๐˜ถ๐˜จ๐˜ข๐˜ณ ๐˜ฅ๐˜ฆ ๐˜ท๐˜ฐ๐˜ต๐˜ข๐˜ค๐˜ชรณ๐˜ฏ. ๐˜Œ๐˜ญ ๐˜ค๐˜ฐ๐˜ฏ๐˜ฅ๐˜ข๐˜ฅ๐˜ฐ ๐˜ฅ๐˜ฆ ๐˜—๐˜ช๐˜ฏ๐˜ข๐˜ญ ๐˜ต๐˜ช๐˜ฆ๐˜ฏ๐˜ฆ ๐˜ฅ๐˜ฆ๐˜ณ๐˜ฆ๐˜ค๐˜ฉ๐˜ฐ ๐˜ข ๐˜ณ๐˜ฆ๐˜ค๐˜ฉ๐˜ข๐˜ป๐˜ข๐˜ณ ๐˜ญ๐˜ข ๐˜ข๐˜ด๐˜ช๐˜ด๐˜ต๐˜ฆ๐˜ฏ๐˜ค๐˜ช๐˜ข *

* ๐˜‹๐˜ฆ๐˜ฃ๐˜ช๐˜ฅ๐˜ฐ ๐˜ข ๐˜ญ๐˜ข ๐˜ฑ๐˜ข๐˜ฏ๐˜ฅ๐˜ฆ๐˜ฎ๐˜ช๐˜ข ๐˜ฅ๐˜ฆ ๐˜Š๐˜–๐˜๐˜๐˜‹-19, ๐˜ฆ๐˜ด ๐˜ฑ๐˜ฐ๐˜ด๐˜ช๐˜ฃ๐˜ญ๐˜ฆ ๐˜ฒ๐˜ถ๐˜ฆ ๐˜ฏ๐˜ฐ ๐˜ฑ๐˜ฐ๐˜ฅ๐˜ข๐˜ฎ๐˜ฐ๐˜ด ๐˜ข๐˜ค๐˜ฐ๐˜ฎ๐˜ฐ๐˜ฅ๐˜ข๐˜ณ ๐˜ต๐˜ฐ๐˜ฅ๐˜ฐ๐˜ด ๐˜ญ๐˜ฐ๐˜ด ๐˜ฆ๐˜ท๐˜ฆ๐˜ฏ๐˜ต๐˜ฐ๐˜ด *
Email address *
Mobile Voter Outreach Van
First/Last Name *
Nombre y apellido
Phone Number *
Nรบmero de telรฉfono
Name of Event
Nombre del evento
Description of event
Descripciรณn del evento
Address of Event *
Direcciรณn del evento
Give us a designation of where you will have the van park.(26 ft long / 8 ft wide / 10 ft 8 in tall) *
Danos una designaciรณn de dรณnde tendrรกs el estacionamiento del van (26 pies de largo / 8 pies de ancho / 10 pies 8 pulgadas de alto)
Name of Organization
Nombre de la organizaciรณn
Date Requesting the Van (*Contingent upon availability*) *
Fecha de solicitud (* Sujeto a disponibilidad *)
MM
/
DD
/
YYYY
Time you want us to arrive (Please include setup time which takes 15 minutes) *
Hora a la que desea que lleguemos (incluya el tiempo de configuraciรณn que demora 15 minutos)
Time
:
Time the van is no longer needed *
Hora en que ya no se necesita la camioneta
Time
:
How many hours needed? *
ยฟCuรกntas horas necesitas?
If needed for longer than 3 hours, please explain why/how the van being at this event for a longer period will benefit the event/community/Pinal County residents.
Si es necesario por mรกs de 3 horas, explique por quรฉ / cรณmo la camioneta que participa en este evento por un perรญodo mรกs largo beneficiarรก al evento / comunidad / residentes del Condado de Pinal.
What Voter Outreach activities are you requesting? *
ยฟQuรฉ actividades de extensiรณn electoral estรก solicitando?
Required
Will we be required to fill out Application and/or pay a Fee for this event? *
ยฟSe nos pedirรก que complete la solicitud y / o pague una tarifa por este evento?
Will we require a special permit to be in the location of the event? *
ยฟRequeriremos un permiso especial para estar en el lugar del evento?
Is this event public & non-partisan? *
ยฟEs este evento pรบblico y no partidista?
Is there electrical hook-up available?
ยฟHay conexiรณn elรฉctrica disponible?
Clear selection
Comments or Questions
Comentarios o preguntas
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Pinal County Government. Report Abuse