119th Congress PCHETA Constituent Support Letters

DEADLINE EXTENDED: Monday, July 6

The Patient Quality of Life Coalition (PQLC) invites you to sign state-specific constituent letters asking your Senators and Representatives for their support of the Palliative Care and Hospice Education and Training Act (PCHETA, S. 2287 & H.R. 4425). The purpose of these letters is to demonstrate to Members of Congress that individuals in their states and districts support the bill and directly request they cosponsor PCHETA. More than 55 national organizations support this legislation along with more than 50 state based organizations, but Senators and Representatives need to hear from their constituents that this issue is important back home.

The draft letters included in this sign-on form are templates. Once we have collected constituent signatures, the letters will be individualized to Members of Congress based on whether:

(1)    they are previous cosponsors who have not yet signed back on to the bill in the current Congress,

(2)    we are asking them to cosponsor the bill for the first time, or

(3)   they are already a cosponsor of the bill, and we want to thank them for their support.

By completing this sign-on form you will be added to the respective letter(s) based on your STATE/DISTRICT.

Please complete this google form to be added to your state's support letter.

WHO CAN SIGN
Constituents from all states and any district are encouraged to sign. In the previous two Congresses, we were able to send a letter to every U.S. Senator which proved to be very effective in demonstrating broad support for the bill. This Congress we are excited to expand this effort to the U.S. House of Representatives.

We are asking individuals to sign this letter, not organizations. Multiple individuals from within any one organization, family, or practice are welcome to sign on.

MORE ABOUT THESE LETTERS:

LETTER #1 will be sent to previous cosponsors to request that they again cosponsor the bill.

LETTER #2 will be sent to all Members of Congress who have never cosponsored PCHETA asking for their support.

LETTER #3 will be sent to Members of Congress to thank them if they are already a PCHETA cosponsor.

COMPLETING THE FORM
Please complete the form below to add your "signature" as a constituent. Each entry will require:

  • FIRST & LAST NAME 
  • (Optional: Institution / Practice / Etc.)
  • HOME STREET ADDRESS (will not be published on the letter but may be needed to determine the correct U.S. Representative)
  • CITY
  • STATE
  • ZIP CODE

This form requires your email address in case we need to contact you with questions about your entry - and your email will be used to send you a copy of the letter(s) once they have been shared with Congressional offices. 

Lastly, please use the drop-down menu to select the PQLC member organization with which you are affiliated, or select "other" if none of the organizations apply and add your organization name in the field below that.

Questions / Contact:
If you need assistance completing this form or have questions about the letters, please contact:
Auda Martinez
auda.martinez@advocacysmiths.com

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Your name and credentials exactly as you want it reflected on the letter - please include at least FIRST & LAST NAME:
(e.g. Jane R. Anderson, MSN)

*
EMAIL: please provide your email in case we have follow-up questions about your form response and so we may send you a copy of the letters once finalized
*
Optional: Institution / Practice / Etc., you want included with your name:
(e.g., Pediatric Palliative Care Team, OU College of Medicine or Attending Physician, Division of Palliative Medicine, Maine Medical Center)

HOME STREET ADDRESS: this will not be used on the letter sent to the Hill but we may need it in order to identify your U.S. Representative
*
HOME CITY *
HOME STATE
*
5-digit HOME ZIP CODE
*
Please identify which PQLC member organization you are affiliated with, or select "other" if none of the options apply (and write-in your organization name in the next field):
*
If you selected "other" in the previous question, please write-in your organization affiliation below:
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