Voter Registration Document

Voter Registration Document

Hello Fellow Students,


My name is Sam Cluggish, and I am emailing you from the CCSR. My project this year focuses on getting as many students registered to vote as soon as possible so that you can join the public discourse and effect direct change in the government. This year, it is especially important that you get registered due to the presidential election happening and two ballot questions that impact life in our state.



If you are filling out the paper registration form, you can mail it OR drop it off at the same dropbox outside city hall where you can drop off mail-in ballots (a white box on the I-93 side).


Track your ballot

Instructions for paper registration form:

Fill in EACH QUESTION with a pen, not a pencil.  

  1. Answer the citizenship question by checking the correct box. You can only register if you are a citizen of the USA. If this is blank, they won’t register you.
  2. Full name
  3. Former name: leave blank unless you have ever changed your legal name.
  4. Address where you live now: Include apartment numbers, town, zip codes.
  5. Address where you receive mail (do you have a P.O. Box? Do you get mail at a different family member’s house?)
  6. Your birthday and year you were born. They cannot process it if you write wrong information here.
  7. Identification number: last 4 of your social security number. If you leave this off, plan to bring some form of identification with you (doesn’t have to be photo ID)
  8. Phone number is optional
  9. Check one
  10. This is only if you were previously registered and moved. If you are registering for the first time, leave #10 blank.
  11. If you are unable to sign yourself, this is the information for someone who is helping you.
  13. The date you are completing the form
  14. You MUST sign and date this form!


There will be two general voter questions on the ballot. This link provides information on those questions: 


Legal Disclaimer:


This is a legal form.  You cannot put any false information on it.  After this form is processed, you can vote in any election until you move out of Medford and re-register in another community.  You are still able to request absentee/mail-in ballots for this election!

Only fill out this form if you are confident you were born in the United States or otherwise became a citizen. None of the teachers or administrators will be seeing who registered and who did not. 

The voter registration deadline for Massachusetts is October 24th, so make sure you get registered as soon as possible. Make sure your parents and other family members are registered as well and also have a plan to vote! If you’re not 18 by this Nov. 3rd election, it’s ok, you can pre-register now and be all set for the next election.


Thank you so much!


Samuel Cluggish


Dan Khoi Nguyen