LEGISLATOR FEEDBACK FORM

PLEASE RETURN:
TODAY: GREAT HALL COLLECTION BOX

FAX: 763.390.0025
MAIL: YIPA 3020 160TH LN NE HAM LAKE, MN 55304

Thank you for participating in the 2012 Youth Day at the Capitol. Please fill out a
feedback form for each meeting that you had, while the information and discussions are
still fresh in your mind. You can leave the forms in the Great Hall collection box.
I (we) met with the following legislator_________________________________________________
on ___________________ (date) at ______________ time.
1. Were you able to talk to this legislator about your organizations youth programs?
YES NO
2. Did this legislator seem supportive of a comprehensive approach to youth policy?
YES NO
Please note any feedback/important information from the meeting:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Does this legislator need any follow-up:
Follow up PERSONAL CONTACT?
Follow up INFORMATION?

YES
YES

NO
NO

Explain:____________________________________________________________________
Name:____________________________________

Organization:__________________________