Advocacy Committee Interest Form

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
E-mail*
Phone*
Legislative District
What is your relationship to the autism community
- Person with autism/autistic
- Parent
- Family member
- Professional
- Educator
- Other
If other, please specify
Please indicate your area(s) of interest. Check all that apply.
- Education
- Transition
- Early intervention
- Improved quality of services
- First responder training
- Employment
- Housing
- Human services (waivers, PCA, etc.)
- Transportation
- Autism specific legislation
- Other
If other, please specify.
What is your availability for in-person meetings or phone calls? Check all that apply.
- Weekday mornings
- Weekday afternoons
- Weekday evenings
- Weekends
Are you interested in joining the AuSM Advocacy Committee Facebook group?
- Yes
- No
- I would like more information
What level of commitment are you interested in making to the AuSM Advocacy Committee?
- I would like to be involved in planning and contacting legislators.
- I am interested in working with the group to get my voice and concerns heard.
- I will contact representatives as needed from my home.
- I want to stay in the loop on the issues, but do not have a lot of time to spend organizing.
- I want to help with research and organizing, but I don't want to talk to people.
- I am not sure yet.
Do you have any previous advocacy experience? Check all that apply.
- I have met with my senators and/or representatives at the Capitol.
- I have written or called lawmakers about issues important to me.
- I have attended marches or rallies for issues important to me.
- I have completed advocacy training through another organization.
- I am a Partners in Policymaking graduate.
- Other
If other, please explain.
Do you have any other comments, questions or concerns about the AuSM Advocacy Committee?