Constituent Mailer Survey

April 2, 2018

Please find a constituent survey below that will allow you to provide input on the issues that are important to you and subjects that may come up during this legislative session.

Your survey responses help guide my work as your representative in the New York State Assembly. I look forward to receiving your input. Please note that there are two spaces available to allow two members of your household to participate.

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Title
First: *
     
Mid:
Last: *
     
Suffix:
Email:
Address: *

     
Apt #:
City: *
     
State: *
     
Zip: *
Phone:
Mobile:
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What concerns you most?

Taxes
Jobs
Education
Health Care
Local Infrastructure
State Spending
Housing Costs
Public Safety
Government Ethics
Economic Development
Other:
Additional issues, questions or concerns: