NASW-CA's “Political Action Posse”
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Advocacy Volunteer Questionnaire

 


 

NASW needs your help!  We are looking for professional social workers or social work students to serve as a resource for the many issues that NASW advocates on.

If you would like to get politically active and help us, please provide the following information:

(Note:  You do not need to be a NASW Member to be a part of the Political Action Posse!)

Contact Information:

First Name

Last Name

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

County

Work Phone

Home Phone

Mobile Phone

E-mail

Educational and Employment Information

Professional Social Worker Designation (BSW, MSW, DSW, LCSW, etc.)

 

Employer1

Employment Title1

Employer2

Employment Title2

Are you a current student

  Yes  No

If you are a student, which program?:

 BSW, MSW,  DSW or PhD

Which University:

Are you a member of NASW? 

  Yes  No

Are you a(n) (check all that apply)

Adult Protective Services Social Worker

Adoption Social Worker

Child and Family Social Worker

Child Protective Services Social Worker

Correctional Social Worker

Geriatrics Social Worker

Government Employee

Medical Social Worker

Mental Health Social Worker

Occupational Social Worker

Private Practitioner

Retired

School Social Worker

Social Service Planner

Social Work Administrator

Social Work Supervisor

Social Work Faculty

Social Work/Welfare Researcher

 

Action Interests:

Are you willing to write a letter to your State Legislators, Governor or other State Agency?

Yes  No

Are you interested in participating in group political events sponsored by NASW-CA, labor groups, consumer groups, and other similar provider organizations in your area? 

Yes  No

Are you interested in participating in group political events sponsored by NASW-CA, labor groups, consumer groups, and other similar provider organizations in Sacramento? 

Yes  No 

Are you interested in providing NASW-CA background material on your issue(s) of expertise when needed? 

Yes  No  

Are you interested in representing NASW-CA by testifying at a Legislative Hearing in Sacramento on your issue(s) of interest, upon request?

Yes  No 

Are you willing to participate in meeting with Legislators or staff in the Legislative district you live in?

Yes  No 

Issues of interest (Check all that apply):

Adult Protective Services

Aging issues, including long term care

Child Care/preschool

Child health & family health (including Healthy Families)

Child Welfare

     Adoption

     Child Protective Services

     Family Reunification & Maintenance

     Family Preservation

     Foster youth emancipation

     Group/residential Care

     Independent Living

     Kinship Care

     Youth development

     Foster Care

 

Criminal Justice & Corrections

     Juvenile Justice

     Gang violence, incl. race relations & police    brutality

Family Law

     Child Custody

     Child Support

 

Human Services Administration

Public Assistance

     CalWORKs

     Supplemental Security Income (SSI)

     General Assistance

     Food Stamps

     In Home Supportive Services (IHSS)

Education (K-12)

     School Social Work

Education (Higher)

     Social Work Education

 

Healthcare Access

Healthcare services/programs including Medi-Cal

Nutrition and Obesity

Medical Social Work

Mental Health

     Children

     Adolescents

     Adults

     Older Adults

Substance Abuse (addictions, alcohol, tobacco, and other drugs)

Military and veterans issues

Developmental Disabilities

Disabled

Domestic Violence

Housing

Immigrants (legal, illegal, refugee, citizenship)

HIV/AIDS

Homeless, including hunger

Women's health (including reproductive health)

 

Civil Rights

     Gender Issues

     Hate Crimes

     LGBT Issues

Community Organizing

Cultural Competency

Private Practice

 

Other (please describe)

THANKS FOR SUBMITTING YOUR FORM AND JOINING NASW-CA'S POLITICAL ACTION POSSE!  WE WILL BE IN TOUCH SOON!

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NASW CA.
Copyright © 2005 NASW  All rights reserved.
Revised: 10/26/06
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