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2. COVID-19 Supply Request Form
   As we prepare to distribute COVID-19 supplies for the NOVEMBER 3 election, we want to get a handle on the supplies you already purchased or may need from us.
4. NOTE: Responses received after Monday, August 31 at 5 p.m. may not be able to be filled.
6. First Name*
8. Last Name*
10. Jurisdiction*

    1. Eagle Lake
    2. Decoria
    3. Lake Crystal
    4. LeRay
    5. Madison Lake
    6. Mapleton
    7. Rapidan
    8. Southbend
    9. St. Clair
12. Phone Number*
14. Cardboard Pillars for Signs and Line Control*

    We can provide cardboard boxes that are 12" wide and 48" tall that will display signs and help with social distancing lines. Do you want these cardboard pillars for your polling place?

    1. Yes
    2. No
16. If YES, how many did you keep from the August Primary?*
18. If YES, how many ADDITIONAL are you requesting? *
20. Curbside Voting Yard Signs*

    We can provide plastic yard signs advertising curbside voting with a spot for you to write your phone number. Do you want these yard signs?

    1. Yes
    2. No
22. If YES, how many did you keep from the August Primary?*
24. If YES, how many ADDITIONAL are you requesting?*
26. 6 foot Social Distance Floor Stickers*

    We can provide vinyl removable floor stickers reminding voters to social distance themselves. We will provide 10 per precinct. Do you want more or less?

    1. A quantity other than 10
    2. 10 is enough
28. If more or less than 10, how many?*
30. Voter Pens*

    We can provide enough pens for voter use (based on historic turnout) on election day, plus a collection pail. The pens and pail will need to be returned after the Primary election. Do you need pens and the pail?

    1. Yes
    2. No
32. Ballot Secrecy Sheets*

    We can provide ballot secrecy sheets to use instead of the ballot privacy folders (quantity based on historic turnout). You will recycle/dispose of these after the election. Do you want these sheets?

    1. Yes
    2. No
34. Face Masks (not shields) for Election Judges*
    How many face masks (the KN95 ones shown in training) do you need? Only one per election judge working in the General will be provided.
36. Face Shields for Election Judges*

    We can provide face shields (the InstaShields and caps, and the bucket hats with vinyl shields) for election judges. We will provide a mixture of the two if you would like them. Do you need them?

    1. Yes
    2. No
38. If YES, how many did you keep from the August Primary?*
40. If Yes, how many ADDITIONAL are you requesting?*
42. Other Items that are Automatically Provided
    We will be providing two hand sanitizer stations (and hand sanitizer), disinfectant spray and towels, and electronic screen cleaner wipes. We will also provide disposable face masks for voters based on historic voter count and the allocations provided by the state.
44. Did you return your two hand sanitizer stations?*

    1. Yes
    2. No
46. Other Needs or Concerns*
    Are there other items or concerns you'd like to share with us? We may be able to help provide them or you could utilize your CARES Act election funds.
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47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit

* indicates a required field