Community Feedback Survey
Count US IN is an Indiana-based movement whose mission is to elevate citizens’ voices and foster inclusive, equitable political participation by encouraging diverse voter turnout, educating citizens on voting rights and protections, combating voter suppression, and cultivating partnerships to create political equity. Count US IN invites you to complete this short survey. Your feedback will help us better tailor our community outreach strategy to meet the needs of our communities and carry out our mission. Please visit our website at for more information.
As of now, are you planning on voting in the upcoming General Election? *
If you answered YES to the previous question, please write a brief statement on why you plan to vote in the upcoming general election.
If you answered NO to the first question, please write a brief statement on why you do not plan to vote in the upcoming general election.
How do you anticipate COVID-19 will affect your ability to vote? *
What area(s) makes voting a challenge for you?
Do you have a current state driver’s license? *
If you need any voting assistance, voting information, or state ID support, please provide us with your email so that we can better serve you and provide resources.
Please rank the following issues in the order of importance to your vote for a political candidate. If you are using a cellphone to complete this survey, please flip it horizontally to access all choices. *
Not at all important
Not important
Very Important
Abortion & Reproductive Rights
Climate Change
Gun Policy
Federal Government Budget
Terrorism and National Security
Criminal Justice / Incarceration
U.S. Tax System
Distribution of Wealth
The Federal Budget Deficit
Black Lives Matter
Foreign Affairs
Women's Rights
How can Count US IN best support you in amplifying your voice and assist you with your voting concerns? *
Are there specific political or social issues that you feel particularly passionate for that are not mentioned above? These can be issues that impact your daily life or causes you care about. Please list these issues below and separate them with commas. *
City and State of Residence *
Age *
Optional: What race(s) do you identify with?
Optional: How would you describe your gender identity?
Optional: How would you describe your orientation?
Optional: Do you have a disability?
Clear selection
If you answered yes to the question above, please describe any challenges voting can pose.
Optional: Are you active military or a veteran?
Clear selection
Optional: What language is most commonly spoken in your home?
Optional: If you have been previously incarcerated, what problems do you face when trying to vote?
If you are an individual or organization that would like to learn more about Count US IN's efforts and how to get involved, please provide us with your name and email to add you to our mailing list. If you wish to remain anonymous, we invite you to follow us on social media @countusindiana
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