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Unity for Community Health: In-District Congressional Meeting Report Form
***Note: A separate form should be completed for each visit.
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Email Address
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Name of Legislator:
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Date of Meeting:
MM
/
DD
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YYYY
Was the Member of Congress present at this meeting?
Yes
No
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Name(s) and Title(s) of Congressional Staff at Meeting:
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Name(s) of Advocates at Meeting:
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Where did this meeting take place? (i.e., State/District Office Location)
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ISSUES DISCUSSED AND SPECIFIC OUTCOMES
Please describe any key takeaways from your meeting (e.g. suggestions for additional advocacy from health centers/NACHC, difficult questions you need help following up on, other policy areas the office would like to discuss, etc.)
Your answer
Please describe any actions that the legislator/staff agreed to take, or any additional information you want to share with NACHC.
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Record any additional comments, observations, or follow-up needs here:
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