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* 1. Member of Congress visited/ Location:

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* 2. Issue focus:

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* 3. Date of the lobby meeting:

Date

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* 4. Participants’ Names:

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* 5. Who did you meet with? If he/she is a staffer, what is his or her role on staff? Provide contact
information if possible.

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* 6. How long did the visit last?

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* 7. What was your specific ask?

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* 8. What was the staff or member of Congress’s reaction? What questions did they ask?

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* 9. What follow-up will you do after the visit?

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* 10. I was listened to by the staff or member of Congress I met with

  1 Strongly disagree 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly Agree Not sure N/A
(1 being "strongly disagree" and 5 being "strongly agree")

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* 11. I enjoyed the process of lobbying.

  1 Strongly disagree 2 Disagree 3 Neither agree nor disagree 4 Agree 5 Strongly agree Not Sure N/A
(1 being "strongly disagree" and 5 being "strongly agree")

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* 12. General comments:

T