Kansas Voter Registration Instructions
For further information, contact the Oce 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 aliation 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 nal discharge from imprisonment,
parole, or conditional 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 ocer 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
condential and will be used for voter registration
purposes only. If you do register to vote, the oce
where you apply will be kept condential and will be
used for voter registration purposes only.
• If this form is incomplete, it may be rejected.
•
Identication number requirements
Enter your current Kansas driver’s license number or
nondriver’s identication 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 purposes only and will not be disclosed to
the public. K.S.A. 25-2309
Rev. 5/23/24 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.
Qualications: 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?
○
Yes
○
No
2. Will you be 18 years of age on or before Election Day?
○
Yes
○
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 dierent 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 Aliation: Choose one:
○
Democratic
○
Republican
○
Libertarian
○
No Labels Kansas
○
United Kansas
○
Not aliated with a party
Complete if previously
registered (please print)
Previous Name Previous Residential Address (Street, City, State, Zip, County)
Signature: I swear or arm 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 oce use only: Ward ______________________ Pct. ______________________ School Dist. ______________________ Member Dist. ______________________
Sen. ________________ Rep. ________________ CoComm ________________ Section ________________ T
ownship ________________ Range _________________
Print in blue or black ink, fold on the center line, seal, and return.
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