Absentee Ballot Request Form

This form can be used to request an absentee ballot for the upcoming election.  This form is to be used only for registered voters in Champaign County.  If you are registered to vote in another County, you will need to contact that County for your voting needs.   The Illinois State Board of Elections has a listing of all election authorities in the state of Illinois, and if you go to the Illinois State Board of Elections website, you can see the entire listing.

International requests and military personnel require an FPCA form.

Any other election related information and/or documents can be found on our election services page.

All fields are required unless otherwise specified.

Personal Information
(Your local information for Champaign County)
First Name:
Last Name:
Local Address:
Local City:
Local Zip:
Date of Birth:
   
Voter Information
(This information is optional, but it helps expedite your request)
Voter Number (optional):
Township (optional):
Precinct (optional):
Code (optional):
   
Mailing Information
(The address where you want your application and ballot sent)
International requests and Military Personnel require an FPCA form.
Mailing Address:
Mailing City:
Mailing State:
Mailing Zip:
   
Contact Information
(Needed in case we have questions in regards to your request)
Phone Number: - -
Email Address:
   
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