Policy Leader and Strategy Room Form

First Name *

Last Name *

Phone *

Email *

Communication Preference *

Call

Text

Level of Policy Engagement

How would you or your organization like to engage with Impact on the Hill’s policy initiatives? *

Co-design or draft new policy frameworks

Serve as an advisory or review body

Support implementation or pilot execution

Lead advocacy or stakeholder engagement

Monitor and evaluate program outcomes

Policy Influence & Networks

What is your current role in shaping or implementing policy? *

Elected or appointed government official

Policy director or advisor

Nonprofit or advocacy organization leader

Research or academic policy contributor

Private-sector or industry policy liaison

Other

Resource Capacity & Supporty & Support

What resources or support can your office/organization contribute to advancing actionable policy outcomes? *

Current Policy Challenge

What major barrier or policy challenge is your team currently working to address—or would like to collaborate on solving? *

Desired Outcomes & Impact

What impact do you hope to achieve by engaging with Impact on the Hill’s Policy Design track? *

Strengthen cross-sector collaboration

Scale proven policy models nationally

Improve equity and access through innovation

Align funding with measurable community outcomes

Other

Follow Up Interest

Would you like to receive invitations to Policy Design Rooms, Strategy Sessions, or follow-up discussions during Impact on the Hill? *

Yes — Policy Design Rooms

Yes — Strategy Sessions

Yes — Both

No, just keep me informed

File Upload for Additional Information

Strategy Rooms

Please share your information so we can connect you with upcoming Strategy Rooms — focused sessions designed for small-group, alignment-ready dialogue across policy, capital, leadership, and execution. You’ll receive updates on dates, topics, and how to participate.

Focus Area (What best describes your interest in Strategy Rooms?) *

Preferred Participation *

Attend sessions

Receive updates only

Interested in facilitating or presenting

Would you like to receive invitations to Strategy Room sessions and related updates?*

Yes — Strategy Rooms & Updates

Yes — Strategy Rooms only

No — just keep me informed