Grassroots Activity Log Form


Instructions: Please provide the NRLN with reports of your contacts with your U.S. Representative, U.S. Senators and/or members of their staffs. The information you provide will be useful to NRLN leaders and the NRLN’s Washington, DC team. It can be used as the basis of follow contacts on Capitol Hill.

  • Enter your report by filling in the appropriate information below.
  • Provide your name, phone number and email address.
  • Note the name of the Senator, Representative or staff member you contacted.
  • Indicate whether the contact was a Phone Call; Drop Off of Information; Face-to-Face Discussion, or Town Hall Meeting.

Click the Blue Button to see the Complete list of Grassroots Codes:

Your evaluation of whether the contact was Positive, Neutral or Negative is important. If the person you met with commits to Sponsor or Co-Sponsor legislation on the topic discussed note that, as it is critical for follow-up action by the NRLN.

Please make as many reports as needed to cover your activities. Thank you for being an active NRLN Grassroots Network member.

If you have a question about the Activity Log or have more information to report than what the Activity Log accommodates, please send an email to

Grassroot Member Information

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