Apply - Fields of Change PAC

State & Local Endorsement Questionnaire

Candidate Name:

Office Sought (Include District or Jurisdiction):

Campaign Website:

Candidate Email:

Candidate Phone Number:

Treasurer Name:

Committee Registration Number (if applicable):

Campaign Mailing Address (for contributions):

Primary Election Date:

General Election Date:

Do you promise to protect and uphold the Constitution?

Yes No

Do you believe that diversity is a strength, not a weakness?

Yes No

Will you stand strong against MAGA extremists?

Yes No

If endorsed, will you display the Fields of Change endorsement on your website?

Yes No

What inspired you to run for office?

Who is a current or former elected official that you admire and why?

What are the three most important issues you’re hearing about from voters in your district?

What are your core values that you espouse the most?