"*" indicates required fields CompanyThis field is for validation purposes and should be left unchanged.Users should generate one report form per legislative race Please answer each question completely and use one report form per legislative race. Please contact Matt Blewett at matt.blewett@edmn.org if you have questions.Local hosting the screening*—Ada-Borup-WestAda-Borup-West ESPAdrianAitkinAitkin ESPAlbanyAlbany ESPAlbert LeaAlbert Lea ESPAlden-CongerAlexandriaAnnandaleAnnandale ESP CustodiansAnoka HennepinAnoka Hennepin ESPAnoka Hennepin ESP Sch/Kind ReadinessArt And Science AcademyAshbyAspiring EducatorsAtwater-Cosmos-Grove CityAustinBadgerBagleyBarnesvilleBarnumBattle LakeBeckerBelgrade-Brooten-ElrosaBelle PlaineBelle Plaine ESPBemidjiBemidji ESPBemidji Regional InterdistrictBensonBenton-StearnsBertha-HewittBertha-Hewitt ESPBig LakeBlackduckBlooming PrairieBloomingtonBloomington ESPBlue Earth AreaBoldBrahamBrainerdBrainerd ESP Educational AssistantsBrainerd ESP Food ServiceBrandon-EvansvilleBreckBreckenridgeBrewster-Round LakeBrooklyn CenterBrowervilleBrowns ValleyBuffaloBuffalo ESPBuffalo Lake-Hector-StewartBurnsvilleBurnsville Cultural Family Liaisons AssociationButterfield-OdinButterfield-Odin ESPByronByron ESPCaledoniaCaledonia ESPCambridge-IsantiCampbell-TintahCanbyCannon FallsCannon Valley CoopCannon Valley Coop ESPCarltonCass LakeCass Lake-Bena ESPCedar MountainCentennialCentral TeachersChaskaChatfieldChisago LakesChisholmChokio-AlbertaClearbrook-GonvickClevelandClimaxClinton-Graceville-BeardsleyClinton-Graceville-Beardsley ESPCloquetColumbia HeightsComfreyCommunity School Of ExcellenceCook CountyCromwell-WrightCrookstonCrookston ESPCrookston ESP Instructional AssistantsCrosby-IrontonDakota County ESPDakota County ESP – Cultural Family AdvocatesDakota County United EducatorsDassel-CokatoDawson-BoydDeer RiverDelanoDetroit LakesDetroit Lakes ESPDilworth-Glyndon-FeltonDover-EyotaDuluthDuluth ESP ClericalDuluth ESP-Integration SpecialistsEast CentralEast Grand ForksEast Grand Forks ESPEden PrairieEden Valley-WatkinsEdgertonEdinaEdina ESP Health ServiceElk RiverEllsworthElyEskoExploration School UnionFairmontFairmont ESPFairmont ESP ParasFaribaultFarmingtonFarmington ESPFergus FallsFergus Falls ESPFertile-BeltramiFillmore CentralFisherFloodwoodFoleyFoley ESPForest LakeForest Lake ESPFosstonFrazeeFreshwater Education DistrictFridleyFridley ESP CustodiansFuldaGibbon-Fairfax-WinthropGlencoe-Silver LakeGlenville-EmmonsGoodhueGoodhue ESPGoodhue County Ed Dist ESPGoodhue County Ed DistrictGoodridgeGranada-Huntley-East ChainGranada-Huntley-East Chain ESPGrand MeadowGrand RapidsGrand Rapids ESP Education AssistantsGrand Rapids ESP SecretariesGreat River SchoolGreenbush-Middle RiverGreenwayGrygla-GatzkeHancockHastingsHastings ESPHawleyHawley ESPHayfieldHayfield-Brownsdale ESPHendricksHenningHermanHermantownHeron Lake-OkabenaHiawatha AcademiesHiawatha Valley Ed DistHiawatha Valley Ed Dist ESPHibbingHill CityHill MurrayHills-Beaver CreekHinckley-FinlaysonHoldingfordHopkinsHoustonHoward Lake-Waverly-WinstedHutchinsonHutchinson ESPIntermediate District 287Intermediate District 916Intermediate District 916 ESP Program AssistantsIntermediate District 917Intermediate District 917 ESP NursesIntermediate District 917 ESP Program AssistantsInternational FallsInternational Falls ESPInver Grove HeightsInver Grove Heights ESPIsleJackson County CentralJanesville-Waldorf-PembertonJordanKasson-MantorvilleKasson-Mantorville ESPKelliherKelliher ESPKenyon-WanamingoKenyon-Wanamingo ESPKerkhoven-Murdock-SunburgKimballKimball ESPKingslandKittson CentralLa CrescentLac Qui ParleLake BentonLake CityLake City ESPLake Crystal Wellcome MemorialLake Of The WoodsLake Park-AudubonLake SuperiorLakeviewLakevilleLakeville ESPLakeville ESP Kid ZoneLancasterLanesboroLaporteLaporte ESPLe Sueur-HendersonLeroy-OstranderLester PrairieLewiston-AlturaLincolnLitchfieldLittle FallsLittlefork-Big FallsLong Prairie-Grey EagleLuverneLyleLyndMabel-CantonMabel-Canton ESPMACCRAYMadeliaMahnomenMahtomediMahtomedi ESPMankatoMaple LakeMaple RiverMarshallMarshall County CentralMartin County WestMartin County West ESPMAWSECOMcGregorMedfordMelroseMelrose ESPMenahgaMenahga ESPMesabi EastMilacaMilroyMinneapolisMinneapolis Jewish Day SchoolMinneotaMinnesota State College FacultyMinnetonkaMinnewaskaMontevideoMonticelloMonticello BIMoorheadMoose LakeMoraMora ESPMorris AreaMorris Area ESPMounds ViewMountain Iron-BuhlMountain LakeMurray County CentralMurray County Central ESPNashwauk-KeewatinNett LakeNevisNew London-SpicerNew London-Spicer ESPNew PragueNew UlmNew Ulm ESPNew York MillsNicolletNorman County EastNorman County WestNorth BranchNorth Branch ESPNorth St Paul-Maplewood-OakdaleNorthfieldNorthfield ESPNorthland Learning CenterNorthland RemerNRHEGNRHEG ESPNW Regional Interdistrict CouncilOgilvieOgilvie ESPOnamiaOronoOrtonvilleOsakisOsseoOsseo ESP AdministrativeOsseo ESP ParaprofessionalsOwatonnaOwatonna ESPPark RapidsParkers PrairiePaynesville AreaPaynesville ESPPelican RapidsPequot LakesPequot Lakes ESPPerhamPierzPierz ESPPillagerPine CityPine IslandPine Island ESPPine River-BackusPipestone AreaPipestone Area ESPPlainview-Elgin-MillvillePrincetonPrinceton ESP CustodiansPrinceton ESP ParaprofessionalsPrinceton ESP SecretariesPrior Lake ESP SecretariesPrior Lake-SavageProctorRandolphRed LakeRed Lake County CentralRed Lake FallsRed Rock CentralRed Rock Central ESPRed WingRed Wing ESPRedwood FallsRenville County WestRenville County West ESPRetiredRichfieldRiver BendRobbinsdaleRobbinsdale Equity AlliesRochesterRochester ESPRock RidgeRockfordRocoriRoseauRosevilleRothsayRound Lake-Brewster ESPRoyaltonRoyalton ESPRum River Special Education CoopRum River Special Education Coop ESPRunestoneRunestone Area Education Dist ESPRush CityRushford-PetersonRushford-Peterson ESPRussell-Tyler-RuthtonSartellSauk CentreSauk Rapids-RiceSebekaSebeka ESPShakopeeSherburne And Northern Wright Special Education CooperativeSibley EastSleepy EyeSouth Koochiching-Rainy RiverSouth St PaulSouth St Paul ESPSouth Washington CountySouthern Plains Education CoopSouthern Plains ESPSouthlandSouthwest MetroSouthwest/West Central Srvc CoopSouthwest/West Central Srvc Coop ESPSpring GroveSpring Lake ParkSpringfieldSt Anthony VillageSt CharlesSt ClairSt CloudSt CroixSt Croix ESPSt Croix River Education DistrictSt FrancisSt JamesSt James ESPSt James ESP CustodiansSt Louis CountySt Louis ParkSt Louis Park ESPSt Michael-AlbertvilleSt PaulSt PeterSt Peter ESPStaples-MotleyState Residential SchoolsStephen-ArgyleStewartvilleStewartville ESPStewartville ESP ParasSwanvilleThief River FallsTorah AcademyTracyTri CountyTri-City UnitedTri-City United ESPTritonTriton ESPTrumanTwin Cities German ImmersionTwin Cities German Immersion ESPUEAUlen-HitterdalUnderwoodUnderwood ESPUnited South CentralUnited South Central ESPUpsalaVerndaleWabasha ESPWabasha-KelloggWabassoWaconiaWaconia ESPWadena-Deer CreekWadena-Deer Creek ESPWalker-Hackensack-AkeleyWarren-Alvarado-OsloWarroadWasecaWatertown-MayerWatertown-Mayer ESPWaterville-Elysian-MorristownWaterville-Elysian-Morristown ESPWaubunWayzataWest Central AreaWest St PaulWestbrook-Walnut GroveWestonkaWheatonWhite Bear LakeWillmarWillow RiverWillow River ESPWin-E-MacWin-E-Mac ESPWindomWindom ESPWinonaWinona ESPWorthingtonWrenshallWright Tech CenterYellow Medicine EastZumbrota-MazeppaZumbrota-Mazeppa ESPEdMN StaffName of person filling out this form*Screening date*Screening action* Recommendation Defer to PAC No Recommendation Election district*–Select One–1A House1B House1 Senate2A House2B House2 Senate3A House3B House3 Senate4A House4B House4 Senate5A House5B House5 Senate6A House6B House6 Senate7A House7B House7 Senate8A House8B House8 Senate9A House9B House9 Senate10A House10B House10 Senate11A House11B House11 Senate12A House12B House12 Senate13A House13B House13 Senate14A House14B House14 Senate15A House15B House15 Senate16A House16B House16 Senate17A House17B House17 Senate18A House18B House18 Senate19A House19B House19 Senate20A House20B House20 Senate21A House21B House21 Senate22A House22B House22 Senate23A House23B House23 Senate24A House24B House24 Senate25A House25B House25 Senate26A House26B House26 Senate27A House27B House27 Senate28A House28B House28 Senate29A House29B House29 Senate30A House30B House30 Senate31A House31B House31 Senate32A House32B House32 Senate33A House33B House33 Senate34A House34B House34 Senate35A House35B House35 Senate36A House36B House36 Senate37A House37B House37 Senate38A House38B House38 Senate39A House39B House39 Senate40A House40B House40 Senate41A House41B House41 Senate42A House42B House42 Senate43A House43B House43 Senate44A House44B House44 Senate45A House45B House45 Senate46A House46B House46 Senate47A House47B House47 Senate48A House48B House48 Senate49A House49B House49 Senate50A House50B House50 Senate51A House51B House51 Senate52A House52B House52 Senate53A House53B House53 Senate54A House54B House54 Senate55A House55B House55 Senate56A House56B House56 Senate57A House57B House57 Senate58A House58B House58 Senate59A House59B House59 Senate60A House60B House60 Senate61A House61B House61 Senate62A House62B House62 Senate63A House63B House63 Senate64A House64B House64 Senate65A House65B House65 Senate66A House66B House66 Senate67A House67B House67 SenateCandidate 1Candidate 1: Name*Candidate 1: Political party*Select oneRepublicanDemocratic-Farmer-LaborLibertarian PartyWe The PeopleGreen PartySocialism and LiberationSocialist Workers PartyJustice For AllIndependentAmericans FirstConstitutional ConservativeForward Party IndependentIndependence-AllianceCandidate 1: Questionnaire complete* Yes No Candidate 1: Does the candidate accept PAC contributions?* Yes No Candidate 1: Questionnaire waiver granted?* Yes No Did you screen a second candidate?* Yes No Candidate 2Candidate 2 Name*Candidate 2: Political party*Select oneRepublicanDemocratic-Farmer-LaborLibertarian PartyWe The PeopleGreen PartySocialism and LiberationSocialist Workers PartyJustice For AllIndependentAmericans FirstConstitutional ConservativeForward Party IndependentIndependence-AllianceCandidate 2: Questionnaire complete* Yes No Candidate 2: Does the candidate accept PAC contributions?* Yes No Candidate 2: Questionnaire waiver granted?* Yes No Did you screen a third candidate?* Yes No Candidate 3Candidate 3 Name*Candidate 3: political party*Select oneRepublicanDemocratic-Farmer-LaborLibertarian PartyWe The PeopleGreen PartySocialism and LiberationSocialist Workers PartyJustice For AllIndependentAmericans FirstConstitutional ConservativeForward Party IndependentIndependence-AllianceCandidate 3: Questionnaire complete* Yes No Candidate 3: Does the candidate accept PAC contributions?* Yes No Candidate 3: Questionnaire waiver granted?* Yes No Did you screen a fourth candidate?* Yes No Candidate 4Candidate 4 Name*Candidate 4: political party*Select oneRepublicanDemocratic-Farmer-LaborLibertarian PartyWe The PeopleGreen PartySocialism and LiberationSocialist Workers PartyJustice For AllIndependentAmericans FirstConstitutional ConservativeForward Party IndependentIndependence-AllianceCandidate 4: Questionnaire complete* Yes No Candidate 4: Does the candidate accept PAC contributions?* Yes No Candidate 4: Questionnaire waiver granted?* Yes No RecommendationRecommended candidate*Rationale*Were there any specific local/regional/issue-based questions asked of the candidates?* Yes No If yes, what were the questions?Of the candidates who screened, did anything stand out as especially positive or negative? Were there red flags or things to highlight? Please describe:Yes votes*No votes*Abstained*Minority opinion
