House District 102 Legislative Request Form

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Thank you for contacting the Office of State Representative Ana-Maria Ramos. To receive assistance with a legislative request or event request, please fill out this form. Include a very detailed description of your request to be appropriately addressed. A Team Ramos staffer will contact you as soon as possible with an update regarding your request.

We look forward to assisting you!

Email *

First Name
*

Last Name
*

Pronouns

She/her/hers

He/him/his

They/them/theirs

Ze/hir/hirs

Other

Clear selection

Phone number
*

Title -if associated with an organization
*

Your address or your organization's address
*

Are you a constituent of House District 102?
*

Yes

Please explain detail why you are contacting the Office of State Representative Ana-Maria Ramos.
*

[If you are requesting new legislation] What is the reason for this bill? (e.g. a recent court decision or regulatory decision, a constituent concern,
a matter raised by local leaders in your district, etc.)

[If you are requesting new legislation] What issues does this bill seek to address? (e.g. a statute needs updating, a governmental entity needs new authority to fulfill its obligation or no longer should be charged with undertaking certain responsibilities, something undesirable occurs too frequently or something desirable occurs too infrequently, an occupation is overregulated or in need of additional oversight, etc.)

[If you are requesting new legislation] How does this bill seek to resolve the issue(s)?

Are you requesting a meeting, and would you be open to meeting with staff? *

I do not need a meeting.

I request a meeting with the Representative only

I request a meeting with the Legislative team

I prefer the Rep., but would like to meet with whomever available

[If you have requested a meeting] What date would this meeting occur? (Please write out the Date, if there is no date for the request write "N/A")

[If you have requested a meeting] Is there a time that you would like to request for this meeting? (Please write out the Time, if there is no time table for the request write "N/A")

[If you have requested a meeting] Please provide the location of the event or the Zoom link Representative Ramos can use to join

PLEASE CHECK "YES, I UNDERSTAND" IF YOU UNDERSTAND THE FOLLOWING INFORMATION: Submissions that do not include information notifying the Representative's office about the issue to be addressed will not receive a response. You will receive a confirmation from our team as soon as possible that we have received your full submission. This form submission is not a confirmation until you have heard from our office. *

Yes, I understand

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Send me a copy of my responses.

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