Name:
Contact e-mail or telephone number:
Constituency (if you don’t the name of your constituency please give us your postcode)
1. Are you a disabled person?
Yes
No
1a. Would you be willing to talk to the media about your experiences of voting?
2. How easy was it to register to vote? Very easy Easy Neither easy nor difficult Difficult Very Difficult
Name of polling station
3. Is the polling station less than ½ a mile from where you live?
4. Is there designated parking for disabled voters close to the polling station?
5. Is there level access into the polling station?
6. If there is a ramp to improve access is it appropriately designed?
7. Is there level access inside the polling station and can a disabled person move around easily and safely?
8. Is there a low-level polling booth?
9. Is there a large print version of the ballot paper on display?
10. Is there a tactile voting device to help visually impaired voters vote independently?
11. Is the polling station well-lit?
12. Are polling station staff helpful and friendly?
19. If you could choose, how would you prefer to cast your vote? at a polling station by post by telephone over the Internet by text message using an electronic terminal at a polling station other…. please give details:
Please make any other comments in the space below:
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