Survey

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Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Telephone Number
Cell Phone Number
Email
Office Sought
Party Affiliation
Campaign Manager / Contact
Campaign Website
Facebook Page
Twitter Handle

In general, INCS Action does not release the answers of these surveys to the public; however, I acknowledge that it reserves the right to do so. I also understand that INCS ACTION PAC will use my answers to the questions above as one of a number of factors in consideration for endorsement of my candidacy.
Name
First Last
Signature
Date
Date Format: MM slash DD slash YYYY

(mm/dd/yyyy)
PLEASE SIGN & RETURN COMPLETED FORM BY Monday, January 6, 2020.

Return options:
• Email a scanned copy to ariel@incsaction.org
• Mail a copy to INCS Action, 150 N. Michigan Ave., Suite 430, Chicago, IL 60601

If you have any questions about this survey, please do not hesitate to contact Ariel Johnson at (773) 370-7179.
Comments
Please use this section if you need to expand on answers to any of the questions in the survey.
Phone
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Charter Public Schools