Advocate Action Survey

Thank you for participating in our Advocacy Campaign in support for people with I/DD. Please complete the brief survey below to help us track our advocacy outreach across the state.

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1. Chapter or agency affiliation (if any)

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2. Why are you invested this advocacy campaign? (check all that apply)

Family Member

Self Advocate

Staff

Community Member

Other (please specify)

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3. Name of state leader(s) engaged

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4. How did you engage them (check all that apply)

In person

Over the phone

Via email

Other (please specify)

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5. Was the feedback from the legislator:

Positive

Negative

Mixed

Unsure

Please share specific feedback or comments

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6. Please share your contact information to engage in future campaigns (optional)

Name

Email address

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* 1. Chapter or agency affiliation (if any)

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* 2. Why are you invested this advocacy campaign? (check all that apply)

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* 3. Name of state leader(s) engaged

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* 4. How did you engage them (check all that apply)

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* 5. Was the feedback from the legislator:

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* 6. Please share your contact information to engage in future campaigns (optional)

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* 7. General comments, stories shared, feedback from participants, etc.

1. Chapter or agency affiliation (if any)

2. Why are you invested this advocacy campaign? (check all that apply)

3. Name of state leader(s) engaged

4. How did you engage them (check all that apply)

5. Was the feedback from the legislator:

6. Please share your contact information to engage in future campaigns (optional)

7. General comments, stories shared, feedback from participants, etc.