SCAPTA Legislative Advocacy Survey

SCAPTA Legislative Survey

Thank you for taking the time to complete this survey to assist the South Carolina Chapter of the American Physical Therapy Association (SCAPTA) in pursuing its legislative and regulatory efforts. This information is being requested as part of SCAPTA's efforts to strengthen our local presence and grassroots network. While we ask that you provide your name and contact information, we want to assure you that this information will remain confidential and will not be uililized by anyone other than SCAPTA staff and governmental affairs team at Mike Daniels and Associates. We encourage you to answer honestly and thoroughly. The more information we have, the better we are able to serve you. Many thanks for your involvement and coorperation.

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* 1. Contact Information:

Name

Company

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. Who is your primary employer?

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* 3. Please list the counties in which you operate and/or provide services.

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* 4. Who are your state legislators? If you do not already know, the best way to find out is by clicking on the following link and following the steps on this web page: http://www.scstatehouse.gov/legislatorssearch.php.

State Senator:

State Representative:

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* 5. Do you consider yourself to be aligned with a particular political party? If so, and you feel comfortable sharing that party affiliation, please do so below:

I would rather not say at this time/ Undecided

Yes, Republican

Yes, Democrat

Yes, Independent

Other (please specify):

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* 6. Are you involved with local, county or state politics i.e. elected office, volunteer, advisory committees, task forces, etc.? If so, please list below:

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* 7. Do you have, or have you had in the past, any direct personal or professional contact with members of the General Assembly or the Governor's Office? If so, please describe the nature of that contact/relationship. Is that contact positive? Or do you view it as more of a negative one? Please explain.

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* 8. Have you been involved in SCAPTA's advocacy and governmental affairs efforts in the past? If so, in what capacity?

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* 9. From the list below, please select all of the ways in which you would feel comfortable being involved in SCAPTA's advocacy efforts? (Check all that apply.)

Meeting with legislators to discuss SCAPTA's legislative priorities.

Writing letters to legislators to support SCAPTA's position.

Calling legislators regarding legislation important to SCAPTA.

Attending local town halls or events for legislators.

Testifying in front of committees on behalf of SCAPTA and/or patients.

Participating on the SCAPTA Legislative Affairs Committee.

Staying up to date and reporting information to colleagues and patients regarding SCAPTA initiatives.

Other (please specify):

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* 10. Are you currently a SCAPTA member?

Yes

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* 11. Please provide any insights about legislative initiatives you believe that SCAPTA should consider along with your willingness to participate in these efforts.