1. CIDNY's November 6, 2012 Individual Voting Survey

* 1. Poll Site Information

* 2. If you have a Disability, please check all that apply: (OPTIONAL - used for demographic statistics only)

* 3. How did you mark your ballot on November 6th?

* 4. Did the poll worker mention that you could use a Ballot Marking Device (BMD)?

* 5. Was the pathway to the BMD and the area around it clear so that you could access it easily?

* 6. Was the poll worker able to give you adequate information so that you could use the BMD successfully?

* 7. Did the BMD work without problems?

* 8. Were you able to vote privately and independently using the BMD?

* 9. Were you able to vote within what you believe is a reasonable amount of time with the BMD?

* 10. Were you able to scan your ballot without problems?

* 11. Did you experience any of the following when you voted? (Check all that apply)

* 12. How would you rate your overall experience voting on November 6, 2012?

* 13. Any suggestions for making improvements for the next election?

* 14. Do you have any other comments you would like to make about your voting experience on November 6th?

* 15. Optional: Your information will be kept confidential. In order to present a report of findings to the Board of Elections, we may want to contact you for further information about your voting experience.