JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
State Senator Contact Result Form
Sign in to Google
to save your progress.
Learn more
* Indicates required question
We use your responses to make sure we are reaching our goals of protecting your voting rights in Nebraska.
Your Name
*
Your answer
Your Email
Your answer
Your Phone
Your answer
Who is your state senator?
*
Your answer
How did you contact your senator?
*
Call
Letter
Email
Social Media
Other:
When did you contact your senator?
MM
/
DD
/
YYYY
What bill did you contact your senator about?
Voter ID
Constitutional Convention
Automatic Voter Registration
Independent Redistricting
Returning Citizen Re-Enfranchisement
Other:
What response did you receive?
Your answer
Do you remember who you spoke to? If so, who?
Your answer
How likely are you to contact your senator again?
Highly likely to contact them again.
1
2
3
4
5
Highly unlikely to contact them again.
Clear selection
Any follow-up information you think we should know?
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Civic Nebraska.
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report
