Question 1

Identify the full name of guideline you have identified. This will be your choice from the three options above: A pending bill, a current policy, or the development of a new bill. Include in your response a direct link to the bill or policy you are referring to or a copy of the health policy. If you are recommending a new bill, please include a one-page draft of your recommendation.

 Question 2

Identify the level at which you will advocate for your bill or policy.

• If its legislation, please let us know whether it falls into the scope of the House or Senate and if it’s at the Federal or State level
• If you chose a healthcare policy, please identify the scope as the community, a facility, an insurance agency etc.

Question 3

Provide a detailed explanation with a minimum of two reasons why this healthcare policy or bill is important. Scholarly support and citations are required.

 Question 5Using this link with your current address, please identify your US legislators. https://www.congress.gov/members/find-your-memberLinks to an external site..  Identify the leader or change agent by name as well as their role from the level you noted in question 2. Tell us who is appropriate to advocate for this policy change or adoption. Example: Ted Cruz, US Senate, Texas; Adam Anderson, State House of Representatives, Florida; Dr. Olivia Smith, Director, Office of Health Equity.  After identifying the appropriate leader or change agent, in 2-4 sentences, describe why this individual is the most appropriate to advocate for this policy change or adoption. 

Question 6

What is the leader or representative’s mailing address AND email address? 

Question 7

State the member of your community who you can elicit feedback from regarding your policy advocacy efforts. Please tell us their first name and their role in your community as well as an email or phone number to contact them. This individual can be a neighbor, coworker, family member etc.. who lives in your community and interacts with the healthcare system in any way (patient family member, healthcare provider). Upload the completed Stakeholder Validation Tool here.