Preparing local people to go the courthouse and face a hostile white reception was a key activity of the summer project. Over 17,000 Mississippi Blacks tried to register to vote over the course of the summer; only 1,600 were successful.
APPLICATION FOR REGISTRATION TO VOTE
1. Write the date of this application____________________________________________
2. What is your full name?______________________________________________________
3. State your age and date of birth_____________________________________________
4. What is your occupation?_____________________________________________________
5. Where is your business carried on? (Give city, town, or village, and street address, if any, but if none, post office address). If not engaged in business, so state._______________________________________________________________________
6. By whom are you employed? (Give name and street address, if any, but if none, post office address). It not employed, so state. ________________________________________________________________________________
7. Where is your place of residence in the county and district where you propose to register? (Give city, town, or village, and street address, if any, but if none, post office address)._____________________________________________________
8. Are you a citizen of the United States and an inhabitant of Mississippi?_____
9. How long have you resided in Mississippi?____________________________________
10. How long have you resided in the election district or precinct in which you propose to register?____________________________________________________________
11. State your last previous place of residence. (Give your street address, if any, but if none, post office address)._______________________________________________
12. Are you a minister of the gospel in charge of an organized church, or the wife of such a minister? If so, what church? (Give address in each instance). ________________________________________________________________________________
13. Check which oath you desire to take: (1)General_____(2)Minister's______ (3)Minister's wife_____(4)Under 21 years at present, but will be 21 years old by date of the general election_____.
14. If there is more than one person of your same name in the precinct by what name do you wish to be called?________________________________________________________
15. Have you ever been convicted of any of the following crimes: bribery, theft, arson, obtaining money or goods under false pretenses, perjury, forgery, embezzlement, or bigamy?________________________________________________________
16. Have you ever been convicted of any other crime (excepting misdemeanor's for traffic violations)?____________________________________________________________
17. If your answer to question 15 or 16 is "yes", name the crime or crimes of which you have been convicted, and the year, court, and place of such conviction or convictions._________________________________________________________________
18. Write and copy in the space below, Section_____of the Constitution of Mississippi:
The applicant will sign here.