2017 YEO Network Membership Survey

1. Basic Information

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Aide Name

Aide's Email

Aide's Phone Number

2. Elected Title (i.e. City Commissioner, Alderwoman, School Board Member, State Representative) *

3. Gender (optional, but strongly recommended)

4. Ethnicity (optional, but strongly recommended)

5. What is your date of birth? (MM/DD/YY) *

6. Which time of day is best to contact you? *

Morning

Afternoon

Other Other

7. Which is the best way to contact you?

Email

Text Message

Calls: Work or Cell

Via Aide

8. What official body are you elected to? (I.e. XYZ County Commission, 123 Unified School District, ZYX House of Representatives) *

9. When is your current elected term up?

Do you plan to run for re-election?

Yes

No

Do you plan to run for higher office?

Yes

No

10. What is your Twitter handle?

What is your Facebook page?

LinkedIn?

YEO Policy 2017

Your answers to these questions help us determine our policy curriculum for 2017.

11. What specific policies within the following issue areas would you like to see the YEO Network focus on in 2017? *

12. Do you consider yourself an authority on any issues? If so, which?

13. What is your main policy goal for the coming year?

14. Have you worked on or advanced a policy based on a YEO Network program or resource? If so, which?

15. What policy sessions would you like to see at the 2017 National Convening?

16. What skills sessions would you like to see at the 2017 National Convening?

17. Do you have trainer or topic recommendations for Teleconferences, Policy Councils/Academies, or National Convenings? *

Your role in the Network, your community, and partner organizations

This brief section of the survey allows us to identify the roles you wish to pursue with the Network, as well as those you currently hold with partner organizations, your elected body, and your community.

18. Are you interested in serving as a mentor to newly-elected YEOs or Fellows in the Front Line Leaders Academy (FLLA) program? If so, please indicate which areas.

Front Line Leaders Academy Fellows

Newly-elected YEOs

None of the above

19. Are you interested in connecting with any of the self-organized caucuses listed below?

20. Do you currently serve in a leadership capacity in your elected body? *

Yes

No

If so, what role? If not, do you plan to? *

21. Can you fundraise for a local or regional YEO event in your area?

Yes

No

22. Can you organize a local or regional YEO event in your area?

Yes

No

23. Are you willing to attend a local or regional YEO event in your area?

Yes

No

24. Are you interested in becoming a YEO Network State Director for 2017? *

Yes

No

Optional Section

This optional portion of the survey is crucial to the continued success of our programming. If you'd like to skip this section and finish the survey, please go to the next page and submit the form.

25. How would you like to see the YEO Network grow and engage members over the next five years?

26. Additional comments, question, or concerns: