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* 1. Please fill in the boxes with your contact information:

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* 2. Which elected officials did you invite? Of these, which were able to attend?

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* 3. Did you encounter any unforeseen problems connecting with your elected official's office? 

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* 4. Please describe any unforeseen problems  you encountered connecting with your elected official's office.

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* 5. Tell us how your event went.

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* 6. Were our resources helpful?

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* 7. If you did not find the resources helpful, what other resources would you find helpful in the future?

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* 8. Did you reach out to any media outlets after the event?

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* 9. If you reached out to the media, which media outlets did you contact?
Please provide a link to the story or video on your event if the outlet(s) have posted it.

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* 10. Do you need additional support from CCAoA to continue your relationship with the lawmakers who attended your PAD event moving forward?  

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* 11. Did you take pictures of your event with your lawmaker?

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* 12. If you took pictures, you can attach them here or send them to takeaction@usa.childcareaware.org. 

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
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* 13. If you uploaded or plan to send pictures, please write 'YES' in the text box below if we have your permission to post these on social media.

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* 14. If you uploaded or plan to send pictures, add your organization or personal social media handles if you want us to tag you in our posts.

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* 15. Please attach a screenshot of your state's proclamation.

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* 16. Is there anything additional you would like to share with us?

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* 17. How likely is it that you would recommend Child Care Aware of America to a friend or colleague?

Not at all likely
Extremely likely

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