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Legislative Meeting Evaluation Sample

1. With whom did you meet? Please note the legislator’s name and the name(s) (first and last) and position of the staff with whom you met.

Legislator: ______________________________________________________

Staff First Name: ____________________ Last Name: ______________________

Staff Member’s Position: _______________________________________________

2. What was the topic of discussion? Was there a specific ask? If so, what was the response?

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

3. Were there any questions you need to follow-up? If so, please list.

_____________________________________________________________________

_____________________________________________________________________

4. What is your plan for follow-up?

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

5. Did the legislator or his/her staff mention a personal connection to breast cancer? If yes, please explain.

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

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