NYSILC Disability Voting Trends – 2012 Post-Election Poll Question Title * 1. Do you have a disability or medical condition that impacts your mobility, hearing, sight, cognitive or mental abilities? Yes. No. (If you respond "no," this survey is primarily for voters with disabilities, you can click the "done" button to register your response.) Question Title * 2. Are you registered to vote? Yes. No. Not sure. (If you respond "not sure," answer the remaining questions to your best knowledge.) Question Title * 3. What is your party affiliation? Democrat. Republican. Independent. Liberal. Conservative. Green Party. Working Families. Libertarian. Other. Describe in the space below: Other (please specify) Question Title * 4. What factors help you to determine how to vote for a candidate? Check any one or all that apply. A. Party affiliation. B. Image. C. Position on key issues that impact the country. D. Position on disability issues. E. Position on issues that impact me personally. F. Political campaign ads. G. How friends and family are going to vote. H. A combination of these factors. I. All of these factors. J. Other. Describe in the space below: Other (please specify) Question Title * 5. Did you vote in the recent election (Election Day 11/6/12/Presidential Election)? Yes. No. (If you respond "no," proceed to question # 13.) Question Title * 6. In the Presidential Election, who did you vote for? Barack Obama (D). Mitt Romney (R). Virgil Goode (I). Gary Johnson (I). Jill Stein (I). Other. Describe in the space below: Other (please specify) Question Title * 7. How did you vote? On Election Day: Marking a ballot and then feeding it through a scanner. On Election Day: Using a Ballot Marking Device (BMD) and then feeding it through a scanner. In advance of Election Day: Marking and submitting an absentee ballot. Other. Describe in the space below: Other (please specify) Question Title * 8. Did you encounter any problems or access issues with the voting technology? Yes. No. Other. Describe in the space below: Other (please specify) Question Title * 9. Did you encounter a physical barrier or any issues at the polling place? Yes. No. Other. Describe in the space below: Other (please specify) Question Title * 10. Did you feel the poll workers were adequately trained and knowledgeable about the voting technology and your needs? Yes. No. Other. Describe in the space below: Other (please specify) Question Title * 11. Were you able to vote privately, without someone seeing your vote choices? Yes. No. Other. Describe in the space below: Other (please specify) Question Title * 12. Were you able to vote independently, by yourself? Yes. No. Other. Describe in the space below: Question Title * 13. Have you ever been trained and or served as a poll worker? Yes. No. Other. Describe in the space below: Other (please specify) Question Title * 14. Have you ever volunteered for an election campaign? Yes. No. Other. Describe in the space below: Other (please specify) Question Title * 15. Have you ever run for elective office? Yes. No. Other. Describe in the space below: Other (please specify) Question Title * 16. If you answered “yes” to the question above, were you successfully elected to office? Yes. No. Other. Describe in the space below: Other (please specify) Question Title * 17. Have you ever contributed funds to a candidate/election campaign? Yes. No. Other. Describe in the space below: Other (please specify) Question Title * 18. Would you ever contribute to a disability Political Action Committee (PAC)? Yes. No. Other. Describe in the space below: Other (please specify) Done