NDP Latino Caucus Membership Form

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Thank you for your interest in joining the Nebraska Democratic Party - Latino Caucus. Please answer the following questions as best you can to help us in our outreach efforts. Our goal is to grow into an active and engaging group that will help us reach Latino voters across the state, recruit and support Latino candidates, and be active in legislation and policy that affect our Latino community. Specific goals will include rural outreach, voter registration efforts, candidate fundraising and campaign support, and providing voting resources in both English and Spanish. Join us and make a difference with our Latino community!

*Please note that you MUST be a registered Democrat to become an official member of this caucus with voting privileges. We also ask that you identify as Latino/Hispanic in order to have voting privlidges. Non-Democratic and non-Latino individuals can still be allies in non-voting capacities. We welcome anyone to support what we do. We will verify voter registration with all membership submissions.*

First Name *

Last Name *

Phone number with area code *

Are you a registered Democrat? (Only registered Democrats will have voting privileges) *

Yes

Email Address *

City *

Zip Code *

County of Residence (Douglas, Lancaster, Sarpy, etc.) *

Please indicate which congressional district you live in. *

CD1 - Parts of Lancaster, Cass, Dodge, Madison, and Sarpy Counties

CD2 - Omaha metro area, parts of Sarpy and Saunders Counties

CD3 - Northeastern, central, and western Nebraska

I don't know

Please indicate which legislative district you live in if known. Please indicate "LD1, LD2, LD3, etc." If you do not know, indicate "N/A." *

Please indicate which City Council District you live in if you live in Omaha or Lincoln. If you don't know or don't live in either city, indicate "N/A." *

Please indicate what other groups (political, nonprofit, business) you are involved with. *Note that this helps us with potential collaborations and coalition-building activities in the future.*

Are you a business owner? If yes, please describe.

Do you possess a special skill set, certification, or unique ability? For example, do you know graphic design, sign language, social media/marketing, artist, musician, grant writing, fundraising, etc?

We support Latino candidates at all levels throughout Nebraska. Are you willing to volunteer to help them win? Select all you are willing to do. *

Canvassing (go door-to-door)

Phone Bank

Postcard Writing

Participate in Cultural Events (Booths, Parades, Rallies, etc.)

Make a Donation

Host a House Party/Fundraiser

Drive Voters to Polling Places

Other:

Required

What are important issues to you as a voter? Select as many as you want. *

Healthcare

Immigration

Jobs/Labor

Education

Mental Health

Climate Change/Environmental Issues

Criminal Justice/Prison Reform

Reproductive Rights

LGBTQIA+2S

Voter Rights

Preserving Democracy

Local and National Economy

Diversity, Equity, and Inclusion (DEI)

Worker Safety & Rights

Gun Reform & Safety

Other:

Required

Is there anything else you would like us to know about you or wish to make a comment?

Do you identify yourself as Latino/Hispanic or any subcategory associated with a Latino country of origin (Example: Mexican, Peruvian, Honduran, or Dominican)? *

Yes

Other:

We rely on supporters like you to keep the caucus running. A donation of $15 will go a long way to support our mission and outreach efforts toward the Latino population in Nebraska. Please consider donating after submission of this form.

If you have any questions regarding the donation, please email us at jose@nebraskademocrats.org.

Yes, I will donate after submitting this form.

No, I choose not to donate at this time.

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