AAPA Congressional Visit Program Participation Form

YES! I WOULD LIKE TO EXPLORE THE POSSIBILITY OF PARTICIPATING IN THE AAPA CONGRESSIONAL VISIT PROGRAM

First Name:

Last Name:

Street Address:

City:

State:

Zip Code:

Home Phone Number:

Work Phone Number:

E-mail Address:

Field of Practice:

Congressional District or Name of Representative:

Have you ever met with your current Senator, Representative, and/or their staff before?

Do you have a special relationship with any of your legislators or their staff? For example, have you ever worked on a campaign or do you know them socially?

Possible dates you might be available to visit:

Best time and way to contact you:

Is there another PA or PA student who might like to accompany you on a Congressional visit?