JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Free to Drive- Coalition Member Survey
Sign in to Google
to save your progress.
Learn more
* Required
Email
*
Your email
Are you interested in being a coalition member for the Free to Drive campaign?
Yes
No
Clear selection
In what ways would you be interested in joining the coalition?
I would be interested in joining the steering committee, which entails helping to plan coalition events.
I would be interested in joining quarterly calls for coalition members.
I would be interested in receiving resources and tools, such as toolkits and webinars, to help advance the campaign's goals.
I would be interested in helping to plan an event in my state.
I would be interested in receiving a quarterly newsletter.
I would be interested in joining a listserve related to driver's license suspension.
Other:
What is the name of your organization?
*
Your answer
Who is the best point of contact for the coalition?
*
Your answer
Which states is your organization working (National, Specific States)
Your answer
What is the email address for the person who will be the point of contact?
*
Your answer
Are you considering a campaign in your state related to driver's license suspension?
Yes, we are planning a campaign for this upcoming cycle.
Not now, but we're open to it.
No, but we're happy supporting campaigns in other states.
Clear selection
In what state(s) do you work?
Your answer
What resources would be most helpful to you in your work?
Trainings on legislative advocacy
Opportunities for peer-to-peer engagement & sharing best practices
Trainings / guides for best practices on messaging
Fact sheets / resources on the impact of driver's license suspension in your state
Technical assistance during your advocacy campaign
Technical assistance on implementing driver's license suspension reforms
Connections to other stakeholders / advocates in your state
Other:
Would you like to be added the Free to Drive Listserv? This group is comprised of members who would like to engage with one another directly on Free to Drive issues. If you do not select membership, you will still receive information from the leadership of Free to Drive.
*
Yes
No
Do you have other groups to recommend to join the coalition? For each group, please include organization name, organization point of contact, and the point of contact's email address.
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Civil Rights Corps.
Report Abuse
Forms
