Skip to content
PAD Engagement with Elected Official Survey
*
1.
Please fill in the boxes with your contact information:
(Required.)
Name
Organization
State/Province
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP/Postal Code
Email Address
*
2.
Which elected officials did you invite? Of these, which were able to attend?
3.
Did you encounter any unforeseen problems connecting with your elected official's office?
Yes
No
4.
Please describe any unforeseen problems you encountered connecting with your elected official's office.
5.
Tell us how your event went.
6.
Were our resources helpful?
Yes
No
7.
If you did not find the resources helpful, what other resources would you find helpful in the future?
8.
Did you reach out to any media outlets after the event?
Yes
No
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.
10.
Do you need additional support from CCAoA to continue your relationship with the lawmakers who attended your PAD event moving forward?
Yes
No
11.
Did you take pictures of your event with your lawmaker?
Yes
No
12.
If you took pictures, you can attach them here or send them to
takeaction@usa.childcareaware.org
.
Choose File
No file chosen
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.
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.
15.
Please attach a screenshot of your state's proclamation.
Choose File
No file chosen
16.
Is there anything additional you would like to share with us?
17.
On a scale of 0 to 10,
How likely is it that you would recommend Child Care Aware of America to a friend or colleague?
0 for Not at all likely, 10 for Extremely likely
Not at all likely
Extremely likely
0
1
2
3
4
5
6
7
8
9
10