Listening Project
Envision the type of West Virginia you want to raise your children, or grow old in.  Fill out the form below to join other West Virginians create the vision they want to inhabit.  This data is being collected in hopes of shaping policies and platforms to address concerns and improve the lives of all West Virginians.
For questions: brandireece@newjobswv.org 
Join our mailing list: mail.newjobswv.org
Volunteer with us: volunteer.newjobswv.org
***Please complete the survey for a chance to win a $50 gift card***
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Email *
Name *
Address
County
 *
Phone
 *
Two current largest WV concerns impacting you and/or loved ones:
One WV victory you would like to see within the next year?
One WV victory you would like to see within the next two years:
How are you impacting or planning to effect change toward your concerns?
What would an ideal first term look like for a new WV governor?
Where would you like to see WV in 20 years?
What one group of people is the most underrepresented in WV?
Clear selection
What is one change you would like to implement in your local neighborhood, community or city/town/county?
How well do you feel the government of WV represents you?
Are you registered to vote?
Clear selection
Do you want to be contacted going forward?
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Do you wish to volunteer?
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THIS QUESTION IS FOR THE INTERVIEWER ONLY.


What issue did you discuss most?

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INTERVIEWER ONLY

Please use this space to take notes.
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