Instructions: Kindly complete this survey in order for your reimbursement to be processed for participating in the Communicating With Washington program. Thank you. Personal Information Form First Name * Last Name * E-Mail Address * Your Visit What day did you visit congress? * Year Year201220132014 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Overall, how did the whole day of visits go on a scale of 1-5 * 1 2 3 4 5 1=Bad & 5=Excellent Please comment about the overall day of visits in Washginton, DC * How many people did you visit?1st Visit Name of Office Scheduled to Visit * Name of Individual Scheduled to Visit * Were you able to attend this scheduled visit? * Yes No Please rate this visit on your sense of how your message was conveyed, on scale of 1-5 * 1 2 3 4 5 1=Poorly & 5=Very Well Please write specific comments about this visit * Please upload your follow up letter here * Please note that even if a scheduled visit was not made a letter will still need to be submitted. Thank you. 2nd Visit Name of Office Scheduled to Visit * Name of Individual Scheduled to Visit * Were you able to attend this scheduled visit? * Yes No Please rate this visit on your sense of how your message was conveyed, on scale of 1-5 * 1 2 3 4 5 1=Poorly & 5=Very Well Please write specific comments about this visit * Please upload your follow up letter here * Please note that even if a scheduled visit was not made a letter will still need to be submitted. Thank you. 3rd Visit Name of Office Scheduled to Visit Name of Individual Scheduled to Visit Were you able to attend this scheduled visit? Yes No Please rate this visit on your sense of how your message was conveyed, on scale of 1-5 1 2 3 4 5 1=Poorly & 5=Very Well Please write specific comments about this visit Please upload your follow up letter here Please note that even if a scheduled visit was not made a letter will still need to be submitted. Thank you. 4th Visit Name of Office Scheduled to Visit Name of Individual Scheduled to Visit Were you able to attend this scheduled visit? Yes No Please rate this visit on your sense of how your message was conveyed, on scale of 1-5 1 2 3 4 5 1=Poorly & 5=Very Well Please write specific comments about this visit Please upload your follow up letter here Please note that even if a scheduled visit was not made a letter will still need to be submitted. Thank you. 5th Visit Name of Office Scheduled to Visit Name of Individual Scheduled to Visit Were you able to attend this scheduled visit? Yes No Please rate this visit on your sense of how your message was conveyed, on scale of 1-5 1 2 3 4 5 1=Poorly & 5=Very Well Please write specific comments about this visit Please upload your follow up letter here Please note that even if a scheduled visit was not made a letter will still need to be submitted. Thank you. 6th Visit Name of Office Scheduled to Visit Name of Individual Scheduled to Visit Were you able to attend this scheduled visit? Yes No Please rate this visit on your sense of how your message was conveyed, on scale of 1-5 1 2 3 4 5 1=Poorly & 5=Very Well Please write specific comments about this visit Please upload your follow up letter here Please note that even if a scheduled visit was not made a letter will still need to be submitted. Thank you. 7th Visit Name of Office Scheduled to Visit Name of Individual Scheduled to Visit Were you able to make this visit? Yes No Please rate this visit on your sense of how your message was conveyed, on scale of 1-5 1 2 3 4 5 1=Poorly & 5=Very Well Please write specific comments about this visit Please upload your follow up letter here Please note that even if a scheduled visit was not made a letter will still need to be submitted. Thank you. 8th Visit Name of Office Scheduled to Visit Name of Individual Scheduled to Visit Were you able to make this visit? Yes No Please rate this visit on your sense of how your message was conveyed, on scale of 1-5 1 2 3 4 5 1=Poorly & 5=Very Well Please write specific comments about this visit Please upload your follow up letter here Please note that even if a scheduled visit was not made a letter will still need to be submitted. Thank you. 9th Visit Name of Office Scheduled to Visit Name of Individual Scheduled to Visit Were you able to make this visit? Yes No Please rate this visit on your sense of how your message was conveyed, on scale of 1-5 1 2 3 4 5 1=Poorly & 5=Very Well Please write specific comments about this visit Please upload your follow up letter here Please note that even if a scheduled visit was not made a letter will still need to be submitted. Thank you. 10th Visit Name of Office Scheduled to Visit Name of Individual Scheduled to Visit Were you able to make this visit? Yes No Please rate this visit on your sense of how your message was conveyed, on scale of 1-5 1 2 3 4 5 1=Poorly & 5=Very Well Please write specific comments about this visit Please upload your follow up letter here Please note that even if a scheduled visit was not made a letter will still need to be submitted. Thank you. Overall Experience Would you come to Washington, DC to lobby for AAS, astronomy and astrophysics again? * Yes No Please comment on how AAS can help improve your lobbying visit to Washington, DC *
