Easterseals Affiliate Congressional Site Visit Evaluation Survey

We appreciate your participation in these events and want to make sure we have met your needs. We do hope that the site visits by your Member of Congress begins or continues to strengthen your association with your federal representatives. Please take a few moments to evaluate the visit and materials from Easterseals Office of Public Affairs/Interactive Marketing.

Please contact Maynard Friesz or Jim Adams at Easterseals Office of Public Affairs with additional responses or to share photographs of your site visit.

Thank you so much for your support of this effort!

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* 1. Please add more details about the Congressional visit to your affiliate.

Senator and/or Representative Name:

Additional congressional staff in attendance:

Date and time of visit:

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* 2. Who all from your affiliate joined in the visit? (i.e., Board Members, Staff, Clients)

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* 3. Did you discuss the impact of Medicaid cuts on your affiliate with the Senator or Representative?

Yes

Please offer any comments on the conversation.

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* 4. Were there any questions/concerns that Easterseals OPA staff should follow-up with when the Member/staff returns to Washington, D.C.?

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* 5. Please rate the site visit and support materials provided.

	Excellent	Very Good	Good	Fair	Poor
How well did the site visit go?	How well did the site visit go? Excellent	How well did the site visit go? Very Good	How well did the site visit go? Good	How well did the site visit go? Fair	How well did the site visit go? Poor
Did you feel prepared?	Did you feel prepared? Excellent	Did you feel prepared? Very Good	Did you feel prepared? Good	Did you feel prepared? Fair	Did you feel prepared? Poor
Were there any questions/concerns that the Senator/Representative asked which needs OPA to follow-up in D.C.?	Were there any questions/concerns that the Senator/Representative asked which needs OPA to follow-up in D.C.? Excellent	Were there any questions/concerns that the Senator/Representative asked which needs OPA to follow-up in D.C.? Very Good	Were there any questions/concerns that the Senator/Representative asked which needs OPA to follow-up in D.C.? Good	Were there any questions/concerns that the Senator/Representative asked which needs OPA to follow-up in D.C.? Fair	Were there any questions/concerns that the Senator/Representative asked which needs OPA to follow-up in D.C.? Poor
How well did they interact with your clients, staff, and others?	How well did they interact with your clients, staff, and others? Excellent	How well did they interact with your clients, staff, and others? Very Good	How well did they interact with your clients, staff, and others? Good	How well did they interact with your clients, staff, and others? Fair	How well did they interact with your clients, staff, and others? Poor
How familiar was the Member with Easterseals before the visit?	How familiar was the Member with Easterseals before the visit? Excellent	How familiar was the Member with Easterseals before the visit? Very Good	How familiar was the Member with Easterseals before the visit? Good	How familiar was the Member with Easterseals before the visit? Fair	How familiar was the Member with Easterseals before the visit? Poor
Did the visit increase the Member’s familiarity on the issue of Medicaid cuts to your programs?	Did the visit increase the Member’s familiarity on the issue of Medicaid cuts to your programs? Excellent	Did the visit increase the Member’s familiarity on the issue of Medicaid cuts to your programs? Very Good	Did the visit increase the Member’s familiarity on the issue of Medicaid cuts to your programs? Good	Did the visit increase the Member’s familiarity on the issue of Medicaid cuts to your programs? Fair	Did the visit increase the Member’s familiarity on the issue of Medicaid cuts to your programs? Poor
Quality of Medicaid Impact materials provided by OPA.	Quality of Medicaid Impact materials provided by OPA. Excellent	Quality of Medicaid Impact materials provided by OPA. Very Good	Quality of Medicaid Impact materials provided by OPA. Good	Quality of Medicaid Impact materials provided by OPA. Fair	Quality of Medicaid Impact materials provided by OPA. Poor

Easterseals Affiliate Congressional Site Visit Evaluation

Question Title

* 1. Please add more details about the Congressional visit to your affiliate.

Question Title

* 2. Who all from your affiliate joined in the visit? (i.e., Board Members, Staff, Clients)

Question Title

* 3. Did you discuss the impact of Medicaid cuts on your affiliate with the Senator or Representative?

Question Title

* 4. Were there any questions/concerns that Easterseals OPA staff should follow-up with when the Member/staff returns to Washington, D.C.?

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* 5. Please rate the site visit and support materials provided.

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* 6. How can OPA better serve your affiliate with federal Medicaid funding?

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* 7. Please supply any additional comments regarding the visit or how Easterseals Office of Public Affairs can better assist with your needs.