Local Representative Feedback Survey Form
Please share your feedback about your local representative. Your responses will help us evaluate and improve their service. All questions relate to your recent experience with your local representative.
Which area or neighborhood do you reside in?
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How often have you interacted with your local representative in the past year?
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Please Select
Never
Once
A few times
Monthly
Weekly or more
How satisfied are you with the overall performance of your local representative?
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1
2
3
4
5
How would you rate your representative's communication with the community?
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Very Poor
1
2
3
4
Excellent
5
1 is Very Poor, 5 is Excellent
How responsive has your representative been to your questions or concerns?
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Not at all
1
2
3
4
Very responsive
5
1 is Not at all, 5 is Very responsive
How trustworthy do you find your local representative?
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Not trustworthy
1
2
3
4
Completely trustworthy
5
1 is Not trustworthy, 5 is Completely trustworthy
How effective has your representative been in addressing local issues?
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Not effective
1
2
3
4
Highly effective
5
1 is Not effective, 5 is Highly effective
What are the most important issues your representative should focus on?
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Public safety
Infrastructure (roads, utilities)
Community events
Environmental concerns
Education
Local business support
Other
Please indicate your level of agreement: My representative listens to community feedback.
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Strongly disagree
Disagree
Neutral
Agree
Strongly agree
What is one thing your representative could improve?
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Additional comments or suggestions
Submit Feedback
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