Community Impact Assessment Form | U.S. House of Representatives

Since taking office, President Trump has issued several controversial executive orders and actions that may have wide-ranging implications for individuals and our greater community. These decisions could influence significant federal funding, longstanding programs, and key initiatives. If you or your organization have been or anticipate being directly affected, please use this form to share details with my office on how these changes impact you.

First Name*

Last Name*

Address*

Street 1 Street 2 City State Zip

Phone Number* () -

Email Address*

Name of Organization or Service Impacted

Executive Action(s) of Concern*

Anticipated Impact of Executive Action (e.g., Funding Feeze)*

YesNo