Down Syndrome Policy Network of TN Survey

Thank you for your commitment to the Down Syndrome Policy Network of TN (DSPNTN)! This important group will advocate for legislation that will improve the lives of Tennesseans with Down syndrome and their families. By joining the group, you are simply agreeing that advocacy is important and that you will help advocate for issues the group determines are important.

Should you have any questions or concerns, always contact Alecia Talbott, Executive Director of DSAMT and co-chair of DSPNTN, at alecia@somethingextra.org or 615-881-4261. Thank you!

Question Title

1. Please tell us about yourself:

Name: *

Address: *

City/Town: *

State: *

ZIP: *

County::

Email Address: *

Cell Phone Number: (or best phone number) *

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2. We hope to have a very diverse group. Please tell us a little about you. Are you a... (select all that apply)

parent of a child with Down syndrome

other family member of a child with Down syndrome

educator

physician

therapist

Other (please specify)

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3. If you have a family member with Down syndrome, what is his/her age(s)?

0-1

2-4

5-10

11-20

21- 39

40+

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4. Do you have any specific advocacy experience, qualifications or knowledge that might be particular helpful to our group?

Yes

If yes, please explain

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5. Which of the following ways are you interested in helping?

Serving in a leadership capacity (chair, secretary, etc.)

Visiting/writing/calling my own representatives

Working with families to help them communicate with representatives

Social media

Drafting materials to be used in advocacy efforts

Answering questions via phone/email

Other

Other (please specify)