New Jersey Voter Registration Application

Check the box if you are a citizen of the United States.

Check the box if you are at least 17 years of age.

If either of the above is not true, do not fill out this form.

Check all that apply:

New Registration
Address Change
Name Change
Signature Update
Change Political Party Affiliation
First Name: Last Name: M: Suffix:

DOB:

Driver's License Number: (Do not include hyphens)

If you do NOT have a driver's license, enter the last 4 digits of your Social Security Number:

If you have neither Social Security nor a driver's license, please check this box:

Home Address: Apt: Municipality: Zip:
Home Address: Apt: Municipality: Zip:
Home Address: Apt: Municipality: Zip:

Important Instructions

Registrants who are submitting this form by mail and are registering to vote for the first time: If you do not have any of the information required by section 5 (regarding your drivers licence number), or the information you provide cannot be verified, you will be asked to provide a COPY of a current and valid photo ID, or a document with your name and current address on it to avoid having to provide identification at the polling place.

Note: ID Numbers are Confidential and will not be released by any governmental agency. Any person who uses such numbers illegally shall be subject to criminal penalties.

If you are homeless, you may complete section 6 (home address) by providing a contact point or the location where you spend most of your time

You may declare a political party affiliation or you may declare to be unaffiliated, regardless of any prior party affiliation. If you are a previously affiliated voter who wants to change political party affiliation or become unaffiliated, you must file this form no later than 55 days before the primary election in order to vote in the primary election. Completing section 10 is OPTIONAL and will not affect the acceptance of your voter registration application.

Need More Information? Check boxes below if you would like to receive more information about:

voting by mail becoming a poll worker polling place accessibility
voting if you have a disability, including visual impairment available election materials in this alternative language ____________________