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?
---Assembly memberSenator

District Type
---Assembly DistrictSenate District

District Number

In which city was the district office you visited?

I visited the district office:
by myselfwith my family/childrenwith 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).