Question Title

* 1. Name

Question Title

* 2. Phone Number

Question Title

* 3. Email Address

Question Title

* 4. Employer or Agency Affiliation

Question Title

* 5. Employer or Agency Address
Including Street Name, City, State and Zip

Question Title

* 6. County of residence (for the purpose of identifying legislative districts)

Question Title

* 7. Why do you want to participate in Advocacy Boot Camp? (300 word limit)

Question Title

* 8. What topics are you interested in advocating on behalf of?

Question Title

* 9. Prevention Action Alliance may, in the future, contact you about advocacy opportunities including but not limited to making phone calls, sending emails, or providing written or in-person testimony to our legislators. 

As a graduate of this program would you be willing to advocate, when necessary, for prevention efforts in the State of Ohio?

Question Title

* 10. I understand that space is limited and I will take full advantage of the learning cohort by attending all meetings.

The meeting dates are:
Monday, November 15th from 2:00 PM - 5:00 PM.
Monday, November 22nd from 2:00 PM - 4:00 PM
Monday, November 29th from 2:00 PM - 4:00 PM
Monday, December 6th from from 2:00 PM - 4:00 PM
Monday, December 13th from from 2:00 PM - 4:00 PM

Question Title

* 11. I understand that part of the learning process is to complete work on my own time, outside of the scheduled meeting times. 

I understand that it is my responsibility to complete this work prior to the next scheduled meeting.

I understand that technical assistance is available at any time to assist me with this work. 

Question Title

* 12. I understand that the virtual sessions associated with this training will be recorded, including audio and video, and may be rebroadcast.

I consent to participate in this recorded session.

0 of 12 answered
 

T