Welcome to the VERA 2016 Program Sign-Up Form!

The Voter Education, Registration, and Action (VERA) 2016 Campaign is a non-partisan effort aimed at adult literacy learners and program staff in the New England states. Its goal is to educate adult learners about voting and the topical election issues, and to mobilize them to vote in the 2016 election. VERA is sponsored by the New England Literacy Resource Center (NELRC) at World Education. Thank you for joining VERA! You can find VERA resources at www.nelrc.org/VERA.

Please fill out this survey form. You will need to fill in something for each box, even a zero or N/A.

Question Title

* 1. Contact Information:

Your Name

Program Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Question Title

* 2. Participating Teacher #1

Name

Email Address

Question Title

* 3. Participating Teacher #2

Name

Email Address

Question Title

* 4. Participating Teacher #3

Name

Email Address

Question Title

* 5. By joining VERA, the program and each class that joins make a commitment to do each of the following. Please indicate your agreement by clicking on each bullet:

Teach about representative democracy, voting and topical election issues.

Encourage and help eligible students and staff register and vote.

Encourage non-eligible students to talk to family members and friends who can vote.

Participate in a New England-wide mock election to see how our students’ results compare to the actual election count.

Track (to the best of your ability) how many students registered, how many voted, and how many voted for the first time. Submit these to NELRC through an online survey after the election.

Question Title

* 1. Contact Information:

Question Title

* 2. Participating Teacher #1

Question Title

* 3. Participating Teacher #2

Question Title

* 4. Participating Teacher #3

Question Title

* 5. By joining VERA, the program and each class that joins make a commitment to do each of the following. Please indicate your agreement by clicking on each bullet:

Question Title

* 6. Program home: