Public Policy Input Information Form
Share your perspectives and feedback to help shape public policy decisions.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number (optional)
Please enter a valid phone number.
Format: (000) 000-0000.
Age Group
*
Please Select
Under 18
18-24
25-34
35-44
45-54
55-64
65 or above
Region/Location
*
Please Select
North
South
East
West
Central
Other
Occupation/Role
*
Please Select
Student
Employed (Private Sector)
Employed (Public Sector)
Self-Employed
Retired
Unemployed
Other
Which policy area are you providing input on?
*
Please Select
Healthcare
Education
Environment
Economic Development
Public Safety
Transportation
Other
How strongly do you agree with the current policy approach in this area?
*
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
Please rate the importance of the following policy goals for this area:
*
Rows
Not Important
Slightly Important
Moderately Important
Very Important
Essential
Affordability
1
2
3
4
5
Accessibility
6
7
8
9
10
Sustainability
11
12
13
14
15
Innovation
16
17
18
19
20
Equity
21
22
23
24
25
What are your top three priorities for improvement in this policy area?
*
Increase funding
Improve access
Enhance transparency
Promote innovation
Support vulnerable groups
Strengthen enforcement
Other
Please provide specific suggestions or comments regarding this policy area.
*
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