The following individuals may apply to participate in the Program: An individual acting on the individual’s own behalf; A parent or guardian acting on behalf of a minor who resides with the parent or guardian; A guardian acting on behalf of a disabled person; or An individual who resides in the same household as an eligible applicant or Program participant. Form. A person seeking to keep the person's residence address, telephone number, and email address of a record confidential shall apply in writing on a form approved by the State Administrator. The form shall be filed: At the appropriate local board if the applicant wishes to keep the applicant's residence address, telephone number, and email address provided on a voter registration application confidential; or At the State or local board at which the applicant filed the certificate of candidacy or statement of organization if the applicant wishes to keep the applicant's residence address, telephone number, or email address provided on a certificate of candidacy or statement of organization confidential. A person seeking confidentiality need not complete the form if: A person is a participant in the program described in Courts and Judicial Proceedings Article, §3-2403, Annotated Code of Maryland, and the Administrative Office of the Courts notifies the State Board; or A person is a participant in the program described in State Government Article, §7-303, Annotated Code of Maryland, and the Secretary of State notifies the State Board. Contents. In the application, the applicant shall: Explain the basis for the request; Attach any documentation in support of the request, which may include: Proof of employment; Certified law enforcement, court, or other federal or State agency records or files; Documentation from a domestic violence, sexual assault, or human trafficking prevention or assistance program; Documentation from a religious, medical, or other professional from whom the applicant has sought assistance or treatment as a survivor of threatened, attempted, or actual domestic violence, sexual assault, stalking, harassment, or human trafficking; or A statement from the applicant about the applicant’s subjective fear; Acknowledge that, notwithstanding approval of the request for confidentiality, the information will be made available: To the jury commissioner; To other public officials as required by law; or Otherwise as may be required by subpoena or other court order; Waive any right of action against the State, the county, the State Board, the local board, or their employees for failing to keep the information confidential; and Swear or affirm, under the penalties of perjury, that the information in and accompanying the request is true.