Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Rep. Moeller's Programs and Events Survey
Our office is happy to host several programs and events throughout the year on a variety of topics. As we plan our year, we would love to hear from you regarding the topics you would like to learn about. The survey should only take a few minutes and will help us ensure that we are providing programs that are helpful to you.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Address or zip code
*
Your answer
Have you ever attended an event or program hosted by the office of Representative Moeller?
*
Yes
No
If you answered "yes" to the following question, please let us know what event(s) / program(s) you have attended.
Your answer
For programs, what topics would you be interested in learning about? (Pick up to four)
*
Information on state-run programs and agencies
Legislative updates from Springfield
Seniors
Public Safety
Veterans
Young children
Women's issues
Financial literacy
Physical and mental health and wellness
Taxes and budgets
The environment and environmental issues
How to save money on utility bills and property taxes
Scams and fraud protection
Education and schools
Business and employment
Transportation
Healthcare
Required
Don't see what you're looking for? Tell us about an event type you'd like to see or a subject you'd like us to cover:
Your answer
How would you prefer we format events? (Pick up to three)
Make the event small, giving attendees the opportunity to meet personally with Rep. Moeller
Make the event large, bringing in a wide range of community organizations and resources that serve a specific demographic
Seminar-style, where attendees sit for an interactive lecture on a specific topic
Work-shop style, where attendees can meet one-on-one with an expert who helps them with an issue
Forum-style, where attendees meet in public for an open discussion to present Rep. Moeller with their questions and concerns
Panel-style, where Rep. Moeller sits for pre-submitted questions with other local or state leaders
Town Hall-style, where Rep. Moeller provides an update on the Illinois General Assembly's legislative session and answers questions related to relevant policy
Committee-style, where attendees meet to discuss a narrow topic, exchanging ideas and providing advice to Rep. Moeller
Open house-style, where attendees visit Rep. Moeller at her office to chat and mingle at their discretion
Community-service oriented, like trash pick-ups, shred-fests, drug take-backs, pet adoptions, donation drives, or electronics recycling
No preference
Thank You!
Thank you very much for taking the time to take our survey; we appreciate it!
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report