Student Advocacy Challenge Record Sheet

Complete and submit this form by September 30. Student Advocacy Challenge scores are tallied based on point values in October, and the winner will be announced at APTA's National Student Conclave.

Please note there are required fields in this form. If you have any questions about the Student Advocacy Challenge or the submission form, please contact Lindsay Still at


Contact Information

Street Address:  
Street Address 2:  
City, State, Zip  

Activity Information

*Date of Advocacy Activity
 [None] Select a Date Delete the Date 
*Name of Legislator:
Type of Legislator
Type of Legislator
*Type of Advocacy Activity:
*Issue Discussed:
Describe your interaction with the legislator and/or the legislator's staff:
Legislator/Staff's Response:
If applicable, how does APTA's Government Affairs staff need to follow up (call, meeting, etc.?)
Additional Comments:

*Denotes Required Field