Change in YOUR Community Starts with YOU! Please Fill Out This Survey So We Can Help!

Please fill out the survey below so we can determine what really matters to you and your community.

“OUR POLITICS IS LOCAL” Community Survey

Email

City, State, Zip Code*

Age

Ethnicity

WhiteBlackHispanicAsianNative AmericanMixed RaceOther

Do you think artists, athletes and entertainers should be more vocal about community issues?

Yes   No

Do you think what’s played on television, radio, and the internet affects how people think and act?

Yes, A lot    Yes, Somewhat   Yes, A little bit   No, Not at all

What do you think of the job elected officials are doing to address your communities’ needs?*

Excellent    Very Good    Okay    Not Good    Poor   Terrible

Which elected office do you think has the most impact on your community?*

President   Governor   State Representative/ State Senator   Mayor   Alderman

Do you think voting makes a difference in your community?*

Big Difference   Some Difference   Very Little   Not at All

Do you consider yourself a member of the hip hop generation?*

Yes   No

Are you a registered voter?*

Yes   No

Did you vote in the last election?*

Yes   No

Please mark the top five areas you think are most important to healthy communities.

Youth and Families   Health and Wellness   Quality Education   Safety/Criminal Justice   Entertainment   Economic Development   Jobs and Employment   Human Rights   Media Justice   Environment and Renewable Energy   Affordable Housing

Please mark the top five community issues you think should be dealt with right away.

Violence   Radio and Television Content   Jobs and Unemployment   Quality Schools   Access to Health Care   Access to Healthy Foods   Programs for Youth   Programs for Ex Offenders   Affordable Housing   Loans for Small Businesses   Support for Parents/Children   Police Misconduct/Bad Cops   Drugs   Domestic Violence   Civic Participation   Low Police Activity   Graffiti   Burglary or Robbery   Gang Activity   Loud Music

Would you be interested in helping to promote a community agenda?*

Yes   No   Maybe

Name

First Last

Phone Number

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