Community-Based Campaigns Intake Form
Organization or Campaign Name
Full Name
First Name
Last Name
Pronouns
He/Him
She/Her
They/Them
Other
If Other, please indicate your Pronouns:
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Describe the issue you are organizing around. What are you trying to accomplish? Is this a policy campaign, organizing effort, or something else?
What is your timeline / how far in the process are you?
Where is your organizing located? Is the issue primarily impacting communities in Los Angeles County?
What community groups are part of this campaign? What capacity do these groups have to organize and build power to achieve the goal?
How does the organizing effort support low-income /POC communities? Who are the primary beneficiaries of your work?
Have you received grant funding, government funding, or some other institutional support for your efforts?
How does your work advance racial and economic justice?
Submit
Should be Empty: