Question Title

* 1. Name and contact info:

Question Title

* 2. Name of Legislator you met with (please fill out a separate survey for each legislator):

Question Title

* 3. What type of meeting?

Question Title

* 4. # of people attending the meeting (include names/description of any key leaders attending the meeting):

Question Title

* 5. Summary of meeting and where the Legislator stands on Medicaid Expansion (include any follow-up needed):

Question Title

* 6. Based on your meeting, how would you rank the legislator's support for Medicaid Expansion:

Question Title

* 7. Based on your meeting, please rate where you think it is possible for the legislator to move (ie. is the legislator currently neutral but you think we can move them to a yes vote):

Question Title

* 8. Any particular "treatment" you think will move the legislator (ie. calls from constituents, meetings with a particular group, LTE's or OP EDs in hometown paper, large meeting with constituents, etc.)

Question Title

* 9. Additional Info you would like to share:

T