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Questionnaire template

Legislative Proposal Feedback

Collects constituents' and stakeholders' awareness of, position on and expected impact of a legislative proposal.

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Nonprofit · Political. All Nonprofit templates

Questions in this template

About You

  1. Thank you for commenting on this legislative proposal. Your feedback will be considered as the proposal is reviewed and debated.

  2. In what capacity are you responding?

    Choose one:

    • As an individual resident
    • On behalf of an organisation
    • As a business owner
    • As a public official or staff member
    • Other

  3. Which organisation are you responding for?

    Condition: Only when responding on behalf of an organisation

    Open answer

  4. Please describe the capacity in which you are responding.

    Condition: Only when Other was selected

    Open answer

  5. Do you live in the area the proposal would apply to?

    Choose one:

    • Yes
    • No
    • Not sure

What You Know About the Proposal

  1. Before today, how familiar were you with this proposal?

    Choose one:

    • Not at all familiar
    • Slightly familiar
    • Moderately familiar
    • Very familiar

  2. Where have you heard or read about the proposal?

    Condition: Only for respondents who already knew about the proposal

    Choose any that apply:

    • News media
    • Social media
    • Updates from an elected official
    • An advocacy or community group
    • Friends, family or colleagues
    • A public hearing or meeting

  3. How clearly have the aims of the proposal been explained to the public?

    Choose one:

    • Very unclear
    • Unclear
    • Neither clear nor unclear
    • Clear
    • Very clear

Your Position

  1. Overall, do you support or oppose the proposal?

    Choose one:

    • Strongly oppose
    • Somewhat oppose
    • Neither support nor oppose
    • Somewhat support
    • Strongly support
    • Undecided

  2. What are the main reasons for your view?

    Condition: Shown once a position is given

    Open answer

  3. How much do you agree with each statement about the proposal?

    • It addresses a real problem.
    • It would treat everyone affected fairly.
    • Its likely costs are reasonable.
    • It could be enforced in practice.

    For each row: choose one:

    • Strongly disagree
    • Disagree
    • Neither agree nor disagree
    • Agree
    • Strongly agree

  4. What do you think should happen to the proposal?

    Choose one:

    • It should pass as written
    • It should pass with changes
    • It should not pass
    • Not sure

  5. What changes would you make to the proposal?

    Condition: Only when the respondent wants it passed with changes

    Open answer

Impact and Next Steps

  1. If the proposal became law, what effect would it have on you or your organisation?

    Choose one:

    • Very negative
    • Somewhat negative
    • No real effect
    • Somewhat positive
    • Very positive

  2. Which groups of people do you think would be most affected, and how?

    Open answer

  3. Which of these, if any, would you be willing to do about the proposal?

    Choose any that apply:

    • Contact my representative
    • Attend a public hearing
    • Submit written comments
    • Share information about it with others
    • None of these

  4. May we contact you if we have follow-up questions about your feedback?

    Choose one:

    • Yes
    • No