2015 General Constituent Survey

1. Would you like to receive my email newsletter, which helps keeps the community up-to-date on my activity, upcoming events, and important legislative developments?
YesNo
2. Would you like to participate in one or more of my Citizens' Advisory Committees?
EducationSpecial Needs
Economic DevelopmentEnvironment
Health CareYoung Adults (Age 15-22)
3. What are your top 3 concerns with the State of Illinois?
State BudgetJobs & Economy
EducationEnvironment
Health CareRetiree Issues
Public Pension ReformCrime/Public Safety
4. What suggestions do you have so that I can continue to better represent you?
5. What types of programs would you like to see me organize and do you have preferred days or times of the week for my events? In the past I have held a variety of outreach events, including Women’s Self-Defense Seminars, Property Tax Relief Workshops, Electronics Recycling and Shred Days, Mobile Office Hours, and much more.
6. Other Concerns/Comments
Name: Email:
Address: Phone:
City: Cell Phone:
Email: