Partners in The Disability Vote PITDV Sign-Up

Partners in The Disability Vote
The Disability Vote includes people living with a disability, family members and friends, advocates, educators, professionals, providers, bureaucrats, and supporters. The disability community has a major stake in the outcome of elections. Issues important to people with disabilities must be part of the conversations and barriers to the election process must be resolved.

disABILITYsa is calling on those who make up The Disability Vote to come together collectively with 3 objectives:
- Make information about candidates, issues, and elections accessible to everyone
- Get people who make up The Disability Vote registered to vote
- Remove barriers and create more equitable access to the polls
Please indicate your level of interest:*

Yes, count us/me in as a partner.I am unsure and would like to discuss this opportunity further.
Business / Organization / Group
Title
Full Name (2 Fields)*

First NameLast Name
Email*
example@example.com
Mobile Phone*
Please enter a valid phone number.
In which district or area do you live?*
In what district or area does your business / organization / group operate:

What issues would you like to have elected officials address at the city level? *
If none, please type N/A
What issues would you like to have elected officials address at the state level? *
If none, please type N/A
Would you like to serve on a team that selects the questions we put forward to candidates during an election?*

Yes, count me in.No, not at this time.
Would you be willing to make follow-up calls or emails to encourage candidates to respond to surveys?*

Yes, count me in.No, not at this time.

As we work to develop a strategy to "Get Out The Vote" to ensure the Disability Vote -people living with a disability, family members and friends, advocates, educators, professionals, providers, bureaucrats, and supporters - have the opportunity to participate, please share with us your current strategies and efforts.
Are you currently engaged in any "Get Out The Vote" initiatives:*

Yes, we are!I'm not sure.Not at this time, and we are able to participate in this way.Not at this time, but we are eager to help those we serve exercise their right to vote.
Please share with us the efforts you are currently making to get those who are part of the Disability Vote registered to vote:*

As we work to remove barriers and create more equitable access to the election process, please share with us your current concerns, strategies, and efforts.
Please describe the barriers you, your constituents, customers, consumers, participants, etc. experience when trying to participate in the election process. (If none, type N/A)*
Are you currently engaged in any efforts to remove barriers to the election process for those living with a disability.*

Yes, we are!Not at this time.I'm not sure.
Please describe the efforts you or your organization is engaged in to help remove barriers for those with disabilities to have access to the polls and other alternative voting mechanisms. *

Would you consider putting your business / organizational / group logo on materials developed by this group collectively?

Yes, we would consider this.No, not at this time.We do not have a logo, but our name can be listed.Maybe, but I am not the decision maker for this.
Your organization's logo will never be used on any material without your prior authorization for each occurrence.
Upload your Business/Organization's Logo Here: *

Your organization's logo will never be used on any material without your prior authorization for each occurrence.
Cancelof
Please contact this person for permissions to use our organization's logo on Partners in The Disability Vote materials: *

First NameLast Name
Email*
example@example.com

Are there any other disability service providers or disability leaders who need to be added to the invitation list for this collective opportunity?

Thank you for your time and investment in this effort. Your participation is greatly appreciated.
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