CA Assembly District 51 - Constituent Survey
Thank you so much for taking the time to answer this survey. This is one of the best ways for us to learn about the needs of the district. Your feedback will help us shape our campaign platform. Our goal is to be a true voice of the district in Sacramento and we can only do that with your help.

If you want to learn more about our campaign, go to MiaForAssembly.com or follow us on Facebook, Instagram or Twitter at @MiaForAssembly. We are the only campaign not taking money from corporations, the fossil fuel industry, charter school lobby, police unions, real estate developers, and the insurance industry. Please consider supporting our grassroots campaign with a donation at tinyurl.com/MiaforAssembly51.

We would be deeply appreciative for your support.

Name *
Email *
Are you a constituent of AD51? *
Zip Code *
Neighborhood *
What are the top 3 issues or things that you worry about being an AD51 Resident? *
Please rank the following issues below in order of personal importance from 1 (most important) to 7: *
1
2
3
4
5
6
Climate Crisis
COVID
Housing
Public Safety
Education
Gun Violence
What kind of support or services do you want out of your State Representative?
Do you have any comments or other issues that you would like us to know about?
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