Application for a Mentor
Application for a Mentor for Municipal Election.
Email *
When Women Run, Women Win!
Full Name? *
Cell phone number?
Email Address?
What office are you seeking? In what area?
Do you have volunteer campaign workers?
Clear selection
Do you have paid campaign staff?
Clear selection
Please list all offices that you have run for or held.
Do you have a competitor in this race?  Please describe.
Why do you want a Mentor?
Do you support increased access to voting and voting rights for all Americans?
Clear selection
Do you believe in equal rights under the law for all women and the passage of a federal Equal Rights Amendment to the U. S. Constitution?
Clear selection
Do you support legislation to protect equal rights for all individuals regardless of gender, race, age, religion, ethnic origin, disability, sexual orientation, or gender identity?
Clear selection
Do you believe that each patient, in consultation with their individual physician, has the right to determine the best medical procedures and practices in regard to reproductive health?
Clear selection
Do you believe a woman has the right to choose an abortion and the right to access safe, legal, confidential, and affordable abortion and reproductive health care and that there should be no required waiting period or other obstruction to accessing an abortion?
Clear selection
Do you support increased access to childcare and other dependent care programs funded from all available sources?
Clear selection
Do you support legislation to eradicate sexism, racism, ageism, poverty, discrimination against the disabled, and discrimination on the basis of religion, and to ensure reproductive freedom and freedom of sexual orientation?
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report