Survey

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1. Please fill out the contact information, including your full name, address, email, and phone number.

Please fill out the contact information, including your full name, address, email, and phone number. Name:
Address:
Address 2:
City/Town:
State:
ZIP:
Email Address:
Phone Number:

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2. Please review the list of our endorsed candidates below and indicate one (1) candidate for whom you would like to volunteer. Many campaigns need volunteers that are able to travel to their particular area, so it is helpful to choose the campaign closest to you. More information about the candidates can be found on our website www.21stcenturydems.org.

Please review the list of our endorsed candidates below and indicate one (1) candidate for whom you would like to volunteer. Many campaigns need volunteers that are able to travel to their particular area, so it is helpful to choose the campaign closest to you. More information about the candidates can be found on our website www.21stcenturydems.org. Gabrielle Giffords (AZ-8)

Barbara Boxer (CA-Sen)

Jim Himes (CT-4)

Alan Grayson (FL-8)

Kendrick Meek (FL-Sen)

Chellie Pingree (ME-1)

Hans Riemer (Maryland - Montgomery Cty. Council At-Large)

John Sarbanes (MD-3)

Mark Schauer (MI-7)

Jocelyn Benson (MI-Sec. of State)

Mark Ritchie (MN-Sec. of State)

Tarryl Clark (MN-6)

Keith Ellison (MN-5)

Carol Shea-Porter (NH-1)

Diane Denish (NM-Gov)

Kirsten Gillibrand (NY-Sen)

Gustavo Rivera (NY-State Senate Dis. 33)

Ted Strickland (OH-Gov)

Kevin Boyce (OH-Treasurer)

Maryellen O'Shaughnessy (OH-Sec. of State)

Steve Driehaus (OH-1)

Mary Jo Kilroy (OH-15)

Ben Nesselhuf (SD-Sec. of State)

Linda Chavez-Thompson (TX-Lt. Gov)

Russ Feingold (WI-Sen)

3. What is the best time to reach you?

What is the best time to reach you?

4. Have you ever volunteered on a campaign before?

Have you ever volunteered on a campaign before? Yes

No

5. What is your age range?

What is your age range? <18

18-25

26-40

41-55

56-70

70+

6. Are you currently:

Are you currently: Employed

Student

Retired

Not Employed

7. How much time are able to commit to volunteering?

How much time are able to commit to volunteering?

8. Are you able to:

Are you able to: Make phone calls

Canvass

Visibility

Other (please specify)

9. If you indicated that you wanted to volunteer for a campaign not in your state are you able to:

If you indicated that you wanted to volunteer for a campaign not in your state are you able to: Volunteer Remotely (please note that not all campaigns have this available)

Travel to Campaign

*1. Please fill out the contact information, including your full name, address, email, and phone number.