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Medicaid Outreach and Advocacy Survey

Allies for Children wants to help you engage around the issues that impact your life and share your story. Sharing your story is one of the most valuable, effective, and important forms of advocacy – it helps to persuade decision makers and move people to action. Ongoing changes to Medicaid means we need to make sure our elected officials and other decisionmakers know the positive impacts that Medicaid has had, as well as the impact of the changes. Sharing a story about how Medicaid has helped you or someone you know ensures we have powerful stories to draw from and share in our work. With your permission, we will share your experiences with others, such as the media and elected officials.
INFORMATION
1.Preferred Name
2.Email address:(Required.)
3.Home Zip Code (to help us determine your legislators):(Required.)
4.Phone Number
5.Best way to contact you (select all that apply):(Required.)
6.Organization / Employer (if applicable):
7.Job Title (if applicable):
8.Your Work Zip Code (if applicable):
9.How would you like to share your story (experiences with Medicaid)?