Hill Visit Report Form

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Please fill out one form per meeting.

What is your name? *

Which state did you represent during your visit? *

What is the first name of the member of Congress? *

What is the last name of the member of Congress? *

What is his/her political affiliation? *

Democrat

Republican

Independent

Did the member of Congress attend the meeting? *

Yes

How many members of your CSMG delegation were present? *

What are the names and titles of congressional staff members who attended the meeting?

Is the member of Congress supportive of providing additional COVID-19 relief that meets the needs of the poor and vulnerable?

Yes

Maybe

Don't Know

Other:

Clear selection

Is the member of Congress supportive of making poor and vulnerable people an international funding priority? *

Yes

Maybe

Don't Know

Other:

Is the member of Congress supportive of immigration reform? *

Yes

Maybe

Don't Know

Other:

What are your impressions of the visit?

e.g. “ They wanted information on impact of (issue) on district”, “Member unlikely to support (issue) due to _______________”, “Member/staff seems supportive of (issue) but wants evidence of constituent backing”

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