Legislative Office Contacts

If a Legislative Office representative contacts your office, staff should gather the following information, without sharing information, and enter it here:

1. Nature of the inquiry: *This question is required.

Please enter an 'other' value for this selection.

2. Contact Information *This question is required.

First Name

Last Name

Title

Representative's Office

Email Address

Phone Number

3. Consumer's Name (if applicable)

4. Email of DORS staff member who entered this information: *This question is required. This question requires a valid email address.