FORM OF APPLICATION FOR REGISTRATION Ward No._______
OFFICE OF REGISTRAR OF VOTERS Prect. No._______
Parish of ____________________, State of Louisiana Cert. No._______
I am a citizen of the United States and of the State of Louisiana, Residence ______________________________
______________________________. My name is Mr. Mrs. Miss ______________________________. I was
born in the State (Country) of _____________________________, on the ________ day of ____________, in the
year ________. I am now ________ years, ________ months and ________ days of age. I have resided in this
state since ____________, in this Parish since ____________, and in Precinct No. ______, in Ward No. ______
of this Parish continuously since ____________. I am not disfranchised by any provisions of the Constitution of
this State. The name of a householder at my present address is ____________________. I am not now registered
as a voter in any other Ward or Precinct of this State, except _________________. My last registration was in
Ward ________, Precinct ________, Parish ___________________. My occupation is ____________________.
My color is ____________. I am now affiliated with the ___________________ Party.
In each of the following items the applicant shall mark through the word "have" or "have not" so that each item
will show a true statement about the applicant.
I have (have not) been convicted of a felony without receiving a full pardon and restoration of the
franchise.
I have (have not) been convicted of more than one misdemeanor and sentenced to a term of ninety (90)
days or more in jail for each conviction, other than traffic and/or game law violations, within five years
before the date of making this application for registration as an elector.
I have not (have) been convicted of any misdemeanor and sentenced to a term of six (6) months or more
in jail, other than traffic and/or game law violations, within one year before the date of making this
application for registration as an elector.
_________________________________ ____________________
Signature Date
Sample Questions
1. The President of the Senate gets his office
a. by election of the people.
b. by election of the Senate.
c. by appointment of the President.
2. The Congress cannot regulate commerce
a. between states.
b. with other countries.
c. within a state.
3. The Articles of Confederation are
a. the Constitution we now have.
b. a plan for State Government.
c. an early plan of Government for the original 13 states.
4. The President is elected
a. by the Congress.
b. by direct vote of the people.
c. by the people through electors.
5. Each state has as many Presidential electors as it has
a. Senators.
b. Representatives.
c. Senators and Representatives.
6. Our Constitution has been changed
a. by the President.
b. by the Congress and the people.
c. by the Supreme Court.
7. The 17th Amendment states that Senators shall be elected by
a. the State of Louisiana.
b. the people of the States.
c. the Congress.