State Legislative Request Intake Form

Name*

First Last

Email*

State

Select your AAUW role or title*

State president
State public policy chair
Branch president
Branch public policy chair
Student leader

Has your state public policy chair been informed of this request?*

Yes
No

Select which AAUW public policy priority this request relates to*

Economic security (e.g. pay equity, minimum wage, retirement security)
Title IX (e.g., athletics, sexual violence on schools and campuses, bullying and harassment)
Education (e.g., charters/vouchers, Common Core, STEM, higher education)
Family-friendly issues (e.g., the Family and Medical Leave Act, paid sick days)
Civil Rights (e.g., the Equal Rights Amendment, LGBT issues, voting rights)
Reproductive rights and health care
Violence against women
Human trafficking

What assistance do you need from AAUW?*

Legislative opinion (e.g., Is the proposed position on this bill or measure consistent with AAUW's public policy program?)
Field assistance or resources (e.g., action alerts, two-minute activist, staff technical assistance)

Background Information

Please provide as much information as possible on the bill or ballot measure for which you are requesting assistance.

Bill or Ballot Measure Number:*

(e.g., H.B. 15)

Title of the bill or measure:

Lead sponsor’s name, party, and district:

Are you working on this bill as a member of a coalition?

Yes
No

Which coalition(s)?

Analysis and AAUW's Role

Please provide as much information as possible so that AAUW can play a unique and useful role.

What is the AAUW member lead's anticipated role on this bill or measure?

Leadership role to support passage of the bill or measure
Member of a coalition to support passage of the bill or measure
Leadership role to oppose passage of the bill or measure
Member of a coalition to oppose passage of the bill or measure

List groups supporting this bill or measure:

List groups opposing this bill or measure:

Is there a deadline? Are there upcoming hearings or anticipated committee actions? What is the timeline in which you need a response from AAUW staff?*

Please provide any links to press coverage of the bill or measure:

Email

This field is for validation purposes and should be left unchanged.

State Legislative Request Intake Form

Background Information

Analysis and AAUW's Role

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