DISTRICT DAY REPORT-BACK FORM

Please Take 5 Minutes to Share With Us How Your District Day Visit Went

Thank you for participating in the Save Service District Day. We hope you had a great time talking to your member of Congress and/or their staff about the critical role and impact of national service in your local community. Your actions, combined with those of hundreds of service supporters from across America, will prove essential in Saving Service in America.

We have one last request. Can you please take 5 minutes to fill out this short report-back form and let us know how your District Day visit turned out? Sharing your District Day experience with us is critical to our Save Service efforts because it gives us an update on where your members of Congress stand on service and insight for how we can best follow up with them to earn their support for service in the future. In addition, being able to accurately tell the story of our District Day efforts nationally, is critical for sharing our results with the White House, members of Congress, and the press.

Taking 5 minutes to fill out this form will help make that possible.

Email Us A Blog About Your District Day Visit

It is absolutely critical that the story of each and every District Day visit be told and your in luck. Sharing your highlights and pictures from your event is as simple as sending a single email to saveservice@posterous.com.

The email subject line will become the title of the blog post
The email body becomes the body of the blog post
And any attachments (images or videos) are included in the blog post.

It's that easy. Please make sure to email your blog post ASAP so your District Day visit gets counted!

If you have any trouble email jsaavedra@servenext.org

Send Us Your District Day Videos

If you took video of your District Day visit, upload it to our facebook page.

Email*

First Name*

Last Name*

Member of Congress Visited (ex. Sen. Tom Harkin)*

Whom did you meet with? (ex. John Doe, Sen. Harkin's State Director)*

Location of event (city/state)*

How many people participated?*

Was the Member of Congress or their staff knowledgeable about the Corporation for National and Community Service and the many ways CNCS funds are being leveraged locally to deliver critical services to their constituents?*

Yes
No

What was the Member's position on FY 12 funds for the Corporation for National and Community Service?*

Supportive
Opposed
Neutral

Is the Member of Congress interested in visiting the site of national service program during an upcoming congressional recess?*

Yes
No

Did the Member of Congress or their staff ask for any specific information that requires follow-up? If so, enter that here. Please be specific about what follow-up would be helpful.

* denotes required field

Join us at:

DISTRICT DAY REPORT-BACK FORM

Please Take 5 Minutes to Share With Us How Your District Day Visit Went

Email Us A Blog About Your District Day Visit

Send Us Your District Day Videos

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