Name
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First Name
Last Name
Email
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Subject
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Message
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What is your Leadership Title?
County commissioner
City council member
Tribal council member
Water district board member
Electric cooperative board member
Other
If other, please specify:
In what city/county and state do you hold this title?
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As a member or potential member of Appalachian Leaders Network, what types of resources would be beneficial to you in your official capacity? (Check all that apply)
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Case studies (e.g. on communities that model clean energy policy, economic diversity, etc.)
News relevant to Appalachian communities
Peer-reviewed papers and reports
Educational webinars and training
Other
If other, please specify:
What types of skill-building would benefit you as a leader? (Check all that apply)
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Lobby training (e.g. how to talk to legislators and communicate your message)
Social media use
Drafting statements and editorials for media
Other
If other, please specify:
What issues are most pressing within the community you serve? (Check all that apply)
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Public lands protection
Water (conservation, quality, diversification of use, etc.)
Air quality
Economic diversity
Clean energy development
Climate change impacts
Please provide details:
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What current, impending or ongoing issues at the state and federal levels most impact your community?
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What types of action might you be willing to take for Appalachian Leaders Network initiatives? (Check all that apply)
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Writing letters-to-the-editor and op-eds for the media
Traveling to meet with policymakers
Signing petitions or letters
Other
If other, please specify:
Would you be interested in attending an annual summit for Appalachian Leaders Network?
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Yes
No
One of the goals of Appalachian Leaders Network is to empower the next generation to seek leadership positions in their communities. As an experienced leader, what resources and materials would be helpful to a first-time campaigner?
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Would you like to be contacted by Appalachian Leaders Network to stay informed on issues affecting Appalachian communities?
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Yes
No
How often would you like to receive news from Appalachian Leaders Network?
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Weekly
Monthly
Do you know other local, Appalachian officials that might be interested in Appalachian Leaders Network?
Additional comments or suggestions: