Thank You

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.