Legislative Contact Sheet

Return to Home page

Name of Legislator: __________________________________________

Date: _____________________ Legislative District: ________________

Name of Arc Member/Supporter: _____________________________

Address (number and street): _________________________________

City, state and zip code: ______________________________________

Phone: _____________________________ E-mail: _____________________________

WAS THE CONTACT MADE BY:

____ In-person appointment
____ Telephone Call
____ Letter
____ E-Mail
____ Phone call

WHAT WERE THE ISSUES DISCUSSED?

Issue __________________________________________________________________________

_______________________________________________________________________________
Response ______________________________________________________________________

_______________________________________________________________________________
Follow-up planned?____________________

ARE THERE ADDITIONAL COMMENTS THAT YOU WISH TO SHARE? _____________________________________________________________________________________

_____________________________________________________________________________________

Please return this form by mail, email, phone or fax to The Arc of Minnesota, 770 Transfer Road, Suite 26, St. Paul, MN 55114. Our fax number is 651-523-0829. You can e-mail this information to Steve Larson at arcmn115@yahoo.com, or leave it by phone by calling 1-800-582-5256 or 651-523-0879 and entering extension #403.