WESTSIDE RISING LDCE Sessions Survey

1.Please enter your contact information.(Required.)

Name

Company/Organization

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

2.I am registering for the following session(s) held the last Tuesday of each month at 3:30 pm(Required.)

January 25, 2022 @ 4 pm

February 22, 2022 @ 4 pm

3.I attended the previous meeting(Required.)

Yes

No

4.What West Side Community do you live or work in?(Required.)

5.I am an individual that...(Required.)

Live

Work

Live & Work on the West Side

Other (please specify)

6.I am a concerned West Side leader that wants to...

Be kept informed about WESTSIDE RISING activities

Attend WESTSIDE RISING Meetings

Participate in trainings

Be a part of the engagement team

Be a Youth Ambassador

Work on issues that impacts the West Side

Participate in outreach activities: Conduct Surveys, Collective door-knocking, phone banking, attend other community meeting to share information with WR.

I have other expertise I'd like to share with community leaders

Other suggestions or expertise you'd like to share with community leaders.

7.How did you hear about the Leadership Development and Civic Engagement Sessions?

8.What additional training would you like WESTSIDE RISING to host?

Suggestion 1

Suggestion 2

Suggestion 3

9.Do you know other people that may be interested in attending these sessions? If so, list their NAME, PHONE NUMBER, and EMAIL ADDRESS.

Person #1

Person #2

Person #3