Candidate Name:
     Candidate for: Congressional District ______

Campaign Name: _________________________________________

Campaign Address: ________________________________________

Do you have a campaign office? ____ If so, is it wheelchair accessible? ____

If you are an incumbent, is your district office accessible to persons with disabilities? _______

Campaign Manager: ______________________________________

Phone: __________________ Fax: _________________________

Email: ___________________ Website: _____________________

Previous elected offices held: ______________________________________

Previous appointed offices held: ______________________________________

Key endorsements:

Community organizations: __________________________________________________

Political leaders: __________________________________________________________

Local community leaders: ___________________________________________________

Labor: __________________________________________________________________

1. Action Shows Commitment

    

   1. While in public office/prior to this campaign, what have you accomplished in regard to advancing disability rights? This can include work towards accessible housing, transportation, employment, health care, education, and including people with disabilities in the political process?

       

       

   2. Will you commit to only attend and/or sponsor events that are accessible to people with disabilities (PWDs) including providing written materials in alternate formats, providing assistive listening systems, and sign language interpreters as well as ensuring that locations are physically accessible?

       

       

2. General Questions:

    

   1. What personal and professional experience have you had with people with disabilities in your personal life and in the workplace?

       

       

   2. Are you willing to hire and to provide reasonable accommodation (e.g. flex or part time) for staff members with disabilities?

       

       

   3. How will you work closely with the disability community to assure passage of vitally needed legislation through the Congress and what will be your strategy?

       

       

3. Legislation

    

   1. The IDEA (Individuals with Disabilities Education Act) Fairness Act would permit parents and guardians who successfully bring an action or proceeding which enforces IDEA to be awarded expert witness fees and certain other expenses. Will you sponsor this legislation?

       

       

   2. The ADA Restoration Act seeks to reassert the original intent of Congress after much weakening by Federal judges appointed by both Presidents Bush. Will you sponsor this legislation?

       

       

   3. The proposed Community Choice Act would allow persons with disabilities and older Americans equal access to community-based attendant supports rather than nursing home placement. Will you sponsor this legislation?

       

       

   4. The Community Living Assistance Services and Supports (CLASS) Act would help individuals with functional impairments and their families to pay for services and supports they need to maximize functionality and independence and have choices about community participation, education and employment. Will you sponsor this legislation?

       

       

   5. The Paul Wellstone Mental Health and Addiction Equity Act would require equity in the provision of mental health and substance-related disorder benefits under group health plans. Will you sponsor this legislation?

       

       

   6. The Christopher and Dana Reeve Paralysis Act would enhance and further research into paralysis and the quality of life for persons living with paralysis and other physical disabilities. Will you sponsor this legislation?

       

       

Date: ______________________