District Office Visit Feedback

Your First Name

Your Last Name

Your Email

Your Phone Number

Legislator First and Last Name

Did you meet with your State Senator or Assembly member?

District Number
---Assembly DistrictSenate District

In which city was the district office you visited?

I visited the district office:
by myselfwith my familywith my homeschool group

Homeschool Group Name

I met with:
my Legislatora Staff Member

If you met with a Staff Member, what was their name?

Who did you leave the Homeschool Information packet with?

Reception was:
WarmNeutralCold

Discussion Time (e.g. 10 minutes)

Comments (please give as much detail about your visit as you can).