Congressional Meeting Report Form
Please fill out one form for each office visited.
Your Name
Date of Meeting
Your Organization/Affiliation
Circle One:
Senator/Representative Name
State/District
STAFF VOLUNTEER OTHER
Staff Person Name, Title
Did you meet with the elected official?
YES
NO
Have you previously met with this office about either of these issues? If so, please list month/year and if
the response has changed:
Family And Medical Insurance Leave (FAMILY) Act (S.786/H.R.1439): Please check all that apply.
☐ Did not discuss
☐ Already a co-sponsor
☐ Will co-sponsor
☐ Supportive, but no co-sponsor commitment
☐ Member/staffer unfamiliar with bill
☐ Staffer was not sure
☐ Will NOT support it
☐ Wants more information
Specific information requested/concerns raised:
Summary of follow-up needed and/or additional comments:
Healthy Families Act (paid sick days) (S.497/H.R.932): Please check all that apply.
☐ Did not discuss
☐ Already a co-sponsor
☐ Will co-sponsor
☐ Supportive, but no co-sponsor commitment
☐ Member/staffer unfamiliar with bill
☐ Staffer was not sure
☐ Will NOT support it
☐ Wants more information
Specific information requested/concerns raised:
Summary of follow-up needed and/or additional comments:
Please return form to Christine Sloane: [email protected], or fax: 202-986-2539.