1.What is your name?

2.What is your email address?

3.What would best describe your primary role within the basic income community.

I am a grassroots advocate, artist or everyday community member. My job isn't related to basic income.

I am a pilot participant. I have been part of an active pilot and received monthly direct cash payments for a duration of time.

I work as a researcher, gathering and analyzing data that supports the idea of basic income.

I work on a team that administers a pilot or multiple pilots.

I work for a foundation or funding entity that supports basic income work.

I work for a government entity that engages with or supports basic income efforts in my region.

I work in the policy space, creating legislation or being an advocate / lobbyist for basic income efforts.

I am an elected official.

Other (please specify)

4.The work I primarily do is:

Local / regional

At the state level

National

Other (please specify)

5.If your work is primarily local / regional or at the state level, let us know what state the work is located in.

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia (DC) Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

6.Let us know how you might want to be part of the National Narrative Change Campaign set to launch in September. This campaign is designed to challenge the false narrative that we live in a meritocracy.

I / my organization wants to help design messaging, graphics or other assets used in the campaign.

I want to tell my story or have my experiences be part of the campaign.

I / my organization wants to participate in a social media campaign by posting or sharing during a coordinated time.

I / my organization wants to host an event to support conversations and engagement with people in the community.

I / my organizations wants to engage our elected officials to build political capital.

I / my organizations wants to integrate legislative work we are doing into the campaign (fighting anti-GBI legislation, promoting GI or cash related legislation in my region/state).

I / my organization does not want to participate in the National Narrative Change campaign.

Other (please specify)

7.Are you interested in participating in policy brainstorming sessions or workshops to explore potential north star policies and processes for supporting legislative work across the community?

Yes

No

Not sure / maybe

8.Are you interested in being part of the Movement Building Coalition that meets every two months to help shape national efforts?

Yes

No

Not sure / maybe

9.Please share any topics or areas that you think are urgent for us to dig into as a movement.