SRC Action Step Survey - Grassroots Democracy

Full Name

Phone Number

Email

Zip Code

Who are you organizing?

For example: I am organizing my workplace, community, or school. (If you are organizing around mutual aid, what type?)

Who will you reach out to to set up a 1:1?

List the first names of the 3-5 people you will reach out to.

How will you reach out to these 3-5 people?

Will you text, talk to them at work in the breakroom, or knock on their door?

One thing you want to ask during these 1:1s

What is one thing you want to make sure you ask about in your meetings?