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CLOSED - Accessible Transportation to the Polls - GA Runoff
Please complete this form to share your needs with our coordinating team. We are a non-partisan 501(c)3 Coalition. We will do our best, but please know we have limited resources and cannot guarantee rides at this time. At this time we RECOMMEND also submitting a request here:
https://orange-cowbell-b6n2.squarespace.com/reserve-your-ride
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What is your full name?
*
Your answer
Address Voter is to be picked up from (street, apt, city)
Your answer
Phone number:
*
Your answer
E-mail:
Your answer
Preferred method of contact
*
Phone
Text
Email
Video call (ASL)
Number of People Requesting Transport
*
Your answer
Transportation Needs
*
Regular vehicle (can fit assistive devices in trunk or seat)
Van with lift or ramp (can transfer to regular seat)
Van with lift or ramp (remain in wheelchair)
Elevator or Ramp Access (at early voting site)
Interpretation Services
Other:
Required
Intended Vote Day
*
Early Voting - Week of December 14
Early Voting - Week of December 21
Early Voting - Week of December 28
Election Day - January 5, 2021
Are you a member of a Tribe like Muscogee, Cherokee, & other 1st Nations/Native ?
*
Yes
No
Other:
Town or City
Your answer
Zip Code
Your answer
County in GA
Your answer
Any additional information? Such as preferred dates or comments?
Your answer
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