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1. Does your state have an Alzheimer’s state plan?
 
Yes
 
No
 
 
 
2. Does your state legislator have an Alzheimer’s task force or committee?
 
Yes
 
No
 
 
 
3. If so are you part of that committee or task force?
 
Yes
 
No
 
 
 
4. Are you involved in any other way?
   
 
 
 
5. Do you know your Alzheimer’s State chapter representative?
 
Yes
 
No
 
 
 
6. Do you work with your Alzheimer’s state representative?
 
Yes
 
No
 
 
 
7. Do you receive constituent calls about Alzheimer’s concerns?
 
Yes
 
No
 
 
 
8. Do you have information in your office about how to help or where to direct the constituent?
 
Yes
 
No
 
 
 
9. Is the available information culturally competent for the Hispanic community?
 
Yes
 
No
 
Not Applicable
 
 
 
10. Are you aware of dementia training requirements?
 
Yes
 
No
 
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