Basic Questions

Please provide the following information. Completing this section will help us understand and promote the Network’s diversity and serve you better and quicker.

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* First Name

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* Last Name

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* Date of Birth (MM/DD/YY)

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* Street 1 

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* Street 2

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* City

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* State

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* Zip Code

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* Email

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* Phone

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* Cell Phone

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* Aide’s Name

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* Aide’s Number

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* Aide’s Email

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* What is your Elected Title? (i.e. City Commissioner, City of Tallahassee; School Board Member, Orange County School Board; State Representative, TN)

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* Level of office (state, local, school, etc.)

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* What is your official government website page?

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* Twitter Handle?

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* Instagram Handle? 

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* Facebook page?

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* LinkedIn?

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* Gender (Optional)

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* What are your pronouns?

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* Sexual Orientation (Optional)

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* Ethnicity (Check all that apply)

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* When is your current elected term up? Do you plan to run again?

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25% of survey complete.

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