1.About You:

First and Last Name:

Email:

Zip Code:

2.How often do you vote in elections?

Every election

Most elections

Some elections

A few elections

None

3.In the past twelve months, have you...[check all that apply]

Signed a petition or sign-on letter

Emailed or called one of your elected officials

Attended a legislative hearing

Attended a school board meeting

Attended a community meeting/town hall on a policy issue

Watched a debate between candidates

Attended a rally or protest

Written to a newspaper or other news outlet about an issue you care about

Prefer not to say

None of the above

4.How familiar are you with the individuals who represent you in Congress? Assume "1 - Not at all familiar" is not knowing their names and "5 - Very familiar" is regularly interacting with them.

1 - Not at all familiar

2

3

4

5 - Very familiar

5.How familiar are you with the individuals who represent you in the Indiana Statehouse? Assume "1 - Not at all familiar" is not knowing their names and "5 - Very familiar" is regularly interacting with them.

1 - Not at all familiar

2

3

4

5 - Very familiar

6.How familiar are you with the individuals who represent you in local government? Assume "1 - Not at all familiar" is not knowing their names and "5 - Very familiar" is regularly interacting with them.

1 - Not at all familiar

2

3

4

5 - Very familiar

7.What is something you hope to learn from this challenge?

8.Please check if any of the following apply to you:

I have previously received services from a Community Action Agency (e.g. energy assistance, Head Start, Housing Choice Voucher, etc.)

I am currently receiving services from a Community Action Agency

I am a staff member at a Community Action Agency

I am a member of the Institute's Advisory Council

I am a concerned citizen looking to get more involved

I am a high school or college student

None of the above

9.Would your organization, class, or group like to join the challenge as a team? Or would you like to join one of our pre-planned teams? Let us know below!

We'll let you know each week which team completed the most challenges.

Team #CommunityAction

Advocates of Tomorrow (age 12-18)

Team #IU

Team #Purdue

DogsAreTheBest

CatsRule

Enter your organization, group, or affiliation:

10.My preferred prizes include:

Grocery store gift cards

Restaurant gift cards

Tickets to events