Civic Influencers Data Form

Name *

First Name

Last Name

Gender Identity *

We strive to create programs and services that represent the full diversity of those we serve. We are asking the following questions about gender and gender identity to ensure that we are meeting this goal. Which of the following best describes you?

Woman

Man

Non-Binary

Agender

Gender Fluid

Gender Queer

Prefer Not to Answer

Prefer to Self-Describe

Do You Identify as Transgender? *

Yes

No

Prefer Not to Answer

What Are Your Pronouns? (Select All That Apply) *

she/her

he/him

they/them

ze/zir

ze/hir

Prefer Not to Answer

Prefer to Self-Describe

Sexual Orientation *

We strive to create programs and services that represent the full diversity of those we serve. We are asking the following question about sexual orientation to ensure that we are meeting this goal. Which of the following best describes you? (Select all that apply.)

Gay

Lesbian

Bisexual

Fluid

Pansexual

Queer

Demisexual

Questioning

Asexual

Heterosexual or Straight

Prefer Not to Answer

Prefer to Self-Describe

Race & Ethnicity *

We strive to create programs and services that represent the full diversity of those we serve. We are asking the following question about race and ethnicity to ensure that we are meeting this goal.

African American or Black

American Indian or Alaska Native

Asian or Asian American

Hispanic, Latinx, or Spanish Origin

Middle Eastern or North African

Native Hawaiian or Pacific Islander

White

Two or More Races

Prefer Not to Answer

Not Listed Here or Prefer to Self-Describe

Do You Identify as a Person with a Disability? *

Yes

No

Are You a First Time Voter? *

Yes

No

Prefer Not to Answer

Are You Part of Your School's Student Government Association, Student Senate, and/or a Civic Engagement Focused Student Organization (Select All That Apply) *

Student Government Association/Student Senate

Civic Engagement Student Organization

Other

NA

Do You Work Another Job? *

Yes - Full-Time and a Student

Yes - Full-Time (Not a Student)

Yes - Part-Time and a Student

Yes - Part-Time (Not a Student)

No - A Student

No - (Not a Student)

How Confident Are You in Your Leadership Skills? *

(1 Being Not at All Confident and 6 Being Very Confident)

1 - Not At All Confident

2

3

4

5

6 - Very Confident

How Confident Are You in Your Public Speaking Skills? *

(1 Being Not at All Confident and 6 Being Very Confident)

1 - Not At All Confident

2

3

4

5

6 - Very Confident

How Comfortable Are You with Initiating Conversations On Voting and Other Issue Areas with Someone You Don't Know? *

(1 Being Not at All Confident and 6 Being Very Confident)

1 - Not At All Confident

2

3

4

5

6 - Very Confident

What Skills Do You Hope to Improve on During This Term with Civic Influencers? (Select All That Apply) *

Creativity

Content Creation

Digital Technology

Data Collection/Analysis

Critical Thinking/Problem Solving

Leadership

Effective Communication

Initiating Conversations

Public Speaking

Community Organizing

Multicultural Fluency

Productivity/Discipline

Professionalism

Teamwork/Collaboration

None of the Above

Other

Tipping Point Index *

We are committed to ensuring young voices and votes matter in our democracy. We have reimagined how and where to engage young voters. Across the country, individuals who wish to control who has access to money and resources in our country are using precise and surgical methods to deprive young people of their right to vote. One of the most meaningful ways to fight this sort of disenfranchisement is with information. Knowing how young people are accessing their civil rights as well as hurdles and the ways this important generation accesses the vote is key to making sure that the civic voice of young people is not silenced. The TPI is a part of the important work to collect information about youth voting as well as what college campuses and communities can do to support youth civic power. The information collected for the TPI is not to punish or call out any one community, campus, or organization, but to help identify areas where we can help bolster the youth voice and ensure that all people have access to their civic power. Please answer all questions to the best of your knowledge. If you are unsure of the answers, you may reach out to professors, faculty, or other colleagues for support. If a question concerns higher education and you are not currently attending please select "Does not apply".

You understand the purpose of the Tipping Point Index.

Was There a Campus Polling Site During the Last Election? *

Yes

No

Unsure

Does Not Apply

Is the Polling Site in Walking Distance? *

Yes

No

Unsure

Does Not Apply

Is There Transportation to the Polls On Your Campus or In Your Community? *

Yes

No

I Don't Know

Are There Any Election-Based Resources on Your Campus Website? *

Yes

No

Unsure

Does Not Apply

Are There Any Civic Engagement Student Groups or Election-Based Centers on Campus? *

Yes

No

Unsure

Does Not Apply

In the Past Year, Have There Been Any Election-Related Events on Your Campus? *

Yes

No

Unsure

Does Not Apply

Do You Get Time Off to Vote from Class or Work? *

Yes

No

I Don't Know

Can Your Student ID Be Used as a Voter ID? *

Yes

No

Unsure

Does Not Apply

Can You Register to Vote On Campus? *

Yes

No

Unsure

Does Not Apply

Does the Campus Participate in NSLVE? *

NSLVE is the National Study of Learning, Voting, and Engagement

Yes

No

Unsure

Does Not Apply

Are There Campus Election Staffing? *

Yes

No

Unsure

Does Not Apply

Is There a Student Voting Coalition on Campus? *

Yes

No

Unsure

Does Not Apply

If a Person Has Been Convicted of a Felony, Are They Still Allowed to Vote in Your District/State? *

Yes

No

I Don't Know