If you do not currently have VAN access and would like to request an HCDP VAN account, please fill out this form completely.

This form is also used to re-activate accounts.

Upon submission, the HCDP Data Department will review your application. In accordance with HCDP Data Policy, a decision will be made determining whether or not your application qualifies for an HCDP VAN account. If approved, a relevant and impermanent VAN account will be granted based on the needs of the individual.

Please fill out all items and a representative from the HCDP Data Department will be in touch.

Name
Voting Address
If none please say none in Address field. 


 Please write: "Precinct ####
4 + 1 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.