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Assemblymember

Sarah Clark

Assembly District 136

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Constituent Concerns Survey

November 17, 2021

I want to hear from you. What priorities do you think I should focus on in the 2022 legislative session?

* Indicates Required Field

Title

First Name *

Middle Initial

Last Name *

Suffix

Phone Number *

Mobile Number

Email

Address (Street Address, P.O. Box, Company Name, c/o)*

Street Address, P.O. Box, Company Name, c/o

Address Line 2 (Street Address, P.O. Box, Company Name, c/o)

Suite, Unit, Building, Floor, etc.

Apt Number

City *

State *

Zip *

1. What concerns you most? (Select all that apply):

COVID19 Effects

Access to Quality Affordable Healthcare

Education Issues

Government Ethics

Food Security

Housing Costs

Childcare Costs

Racial Equality

Local Job Market

Public Safety

Other

2.

Are there any other concerns or thoughts you would like to share with me?

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