Advocate Action Survey

Thank you for participating in our Advocacy Campaign in support for people with I/DD. Please complete the brief survey below to help us track our advocacy outreach across the state.

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* 1. Chapter or agency affiliation (if any)

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* 2. Why are you invested this advocacy campaign? (check all that apply)

Family Member

Self Advocate

Staff

Community Member

Other (please specify)

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* 3. Name of state leader(s) engaged

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* 4. How did you engage them (check all that apply)

In person

Over the phone

Via email

Other (please specify)

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* 5. Was the feedback from the legislator:

Positive

Negative

Mixed

Unsure

Please share specific feedback or comments

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* 6. Please share your contact information to engage in future campaigns (optional)

Name

Email address

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* 1. Chapter or agency affiliation (if any)

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* 2. Why are you invested this advocacy campaign? (check all that apply)

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* 3. Name of state leader(s) engaged

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* 4. How did you engage them (check all that apply)

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* 5. Was the feedback from the legislator:

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* 6. Please share your contact information to engage in future campaigns (optional)

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* 7. General comments, stories shared, feedback from participants, etc.