Share Your Story of Impact - The Policy Circle

To start, please provide your information:

Contact Information

First Name

Last Name

Email Address

Mobile Phone

Next, tell us more about this engagement:

Type of Action/Engagement

Action Taken or Policy InfluencedMeeting Attended/Speaker EngagementCommunity VolunteeringPolitical Volunteering (campaign, poll working, elections, etc.)Taking on Leadership PositionRunning for OfficeMedia Interaction (interview, op-ed, letter to the editor, etc.)Other

Please explain

What level of engagement was this activity?

LocalStateFederal

Now, provide a general summary/leading headline for your engagement:

General Headline/Summary of your Story of Impact:

Last, please provide complete details about this engagement:

Describe your action and/or engagement, providing details about the issue, process, opportunity, key stakeholders, etc.

In thinking about the impact/potential impact, how many individuals/citizens have been/will be impacted by your action or engagement?

In reflecting on this engagement/experience, please share what you learned and the next steps you plan to take:

What obstacles did you face in taking action and/or engaging? How did The Policy Circle help you overcome these obstacles?

We love to celebrate the stories of our impactful leaders! We will reach out to get permission before we share your story, but it would be great to have a current headshot on file so we can celebrate you. Please attach yours below if we do not have it on file, or if you would like to provide an updated photo.

Apply to the Civic Leadership Engagement Roadmap (CLER) Program Today

To start, please provide your information:

Next, tell us more about this engagement:

Now, provide a general summary/leading headline for your engagement:

Last, please provide complete details about this engagement: