Mid-Cities Democrats

Instructions

Answer questions as they relate to the voter. For most answers, check the boxes most applicable to you or fill in the blanks.

Contact Information

First Name

Middle name or initial

Last name

Salutation

Envelope Name

Phone, home

Phone, work

Phone, cellular

E-mail

Permission to send e-mails to you?

	Yes
	No

Contact History

	(Provide up to three responses.)

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Activist

Activist Codes, Constituency/Issues

	(Select all that apply.)
	Doctor/Nurse
	Educator
	Has children
	Labor
	Lawyer
	Women's Issues
	Gun Rights
	Pro-Choice
	Pro-Life
	Lesbian, Gay, Bisexual, Transgender Issues
	Equality Rights
	Environment
	Toll roads
	Immigration
	Eminent domain

Activist Codes, Demographics

	African-American
	Arab-Muslim
	Asian
	Caucasian
	Hispanic
	Jewish

Activist Codes, Party Officials

	(Select all that apply.)
	06 Precinct Convention Attendee
	06 SD/Co Delegate/Alternate
	06 State Convention Delegate/Alternate
	08 Precinct Convention Attendee
	08 SD/Co Delegate/Alternate
	08 State Con Delegate/Alternate
	County Chair
	County Party Secretary
	SDEC
	Mid-Cities Democrats
	CGS Democrats
	HEB Democrats
	North Central Tarrant Democrat
	Elected Official
	Retired elected official
	Precinct Chair
	Democratic Club officer

Activist Codes, Programs and Volunteering

	(Select all that apply.)
	Precinct Program: DNC YOE Target
	Volunteer: Do Not Call
	Volunteer: Volunteer at Elections
	Volunteer Neighborhood Activist
	Volunteer Precinct Chair
	Block Walking
	Phone Bank
	Data Entry
	General Office Work

MCD Participation

	(Select all that apply.)
	Club Officer
	Outreach Committee
	Candidate Recruitment and Support Committee
	Technology Committee
	Membership Committee
	Jim Wright Committee
	Fundraising Committee

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VAN Questions

Polling Location

Political party or leaning

	Democrat
	Republican
	Green
	Libertarian
	Independent
	none

Language fluency, primary language

	English
	Spanish
	French
	German
	Other:

Language fluency, other languages spoken, not necessarily fluent

	English
	Spanish
	French
	German
	Thai
	Hindi
	Other:

Survey Questions

	(Provide up to three responses.)

Neighborhood Relationships

	(Provide up to three responses.)

Voting History

	(Select all that apply.)
	2007 General
	2007 Primary
	2007 May General
	2007 May Municipal
	2008 Primary
	2008 General

VAN ID

Date Registered in VAN

Voter Certificate Number

State Voter ID

Gender

	Male
	Female
	Not stated

Date of Birth

Also in Household

	(Provide up to three responses.)

Notes

	(Provide up to three responses.)

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Districts

County of Residence

	Tarrant County
	Dallas County
	Denton County

Precinct Number

US Congressional District

	24th
	26th
	6th
	12th

Texas State Senate District

	9th
	10th
	12th

Texas House District

	91st
	92nd
	93rd
	94th
	95th
	98th

Board of Education

	Grapevine Colleyville Independent School District
	Other:

County Commissioner

	3rd Precinct
	1st Precinct
	2nd Precinct

J.P./Constable

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