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* 1. Please select the issues that interest you most:

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* 2. Rank these priorities for state government for the next year:

  High Priority Priority Low Priority
Eliminating the minimum wage
Cutting the State Income Tax
Allowing more tax deductions for families
Improving our state's economy
Education
Attract new businesses to Connecticut
Supporting existing businesses
Providing health care for the uninsured
Enhancing public universities
Improving roadways & infrastructure
Regionalism of municipal services
Environmental protection

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* 3. Did the Affordable Care Act (ObamaCare) impact your health insurance?

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* 4. If you own a business, did the Affordable Care Act (ObamaCare) effect your insurance costs?

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* 5. How would you rate Connecticut's economic climate?

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* 6. What do you think about Connecticut's economic outlook?

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* 7. Which statement reflects your views?

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* 8. I believe the best way to stimulate job creation in Connecticut is by...

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* 9. Connecticut faces billion-dollar budget deficits in the coming years despite the largest tax increase in state history just four years ago. If you were tasked with reducing state spending, what path would you take?

  Cut a lot Cut some Cut little Never cut
• Government agencies and departments
• Salaries and benefits for state employees
• Funding for public universities
• Public education funding
• Funding for towns/municipal investments
• Food Assistance Program
• Prison operations
• Housing assistance
• State law enforcement
• Judicial operations

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* 10. If you have any additional questions or concerns for State Rep. Sam Belsito, please fill in the box below.

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* 11. If you would like State Rep. Sam Belsito to respond to your questions or concerns, please leave your contact information below.

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