This form is to let EdMN know what screenings you/your field office is working on. Field office(Required)Select one—AnokaApple ValleyBemidjiBrooklyn ParkDetroit LakesDuluthMankatoMinneapolisNew BrightonRobbinsdaleRochesterSaint PaulSherburneSouthwest MetroSt. CloudWindomWoodburyScreening Date MM slash DD slash YYYY If you have scheduled multiple screenings, please fill out one form per screening.Staff involved in the screeningPlease list all Field Staff and OPS that will be taking part in this screening.MN Senate districts that you will screen 01 Senate 02 Senate 03 Senate 04 Senate 05 Senate 06 Senate 07 Senate 08 Senate 09 Senate 10 Senate 11 Senate 12 Senate 13 Senate 14 Senate 15 Senate 16 Senate 17 Senate 18 Senate 19 Senate 20 Senate 21 Senate 22 Senate 23 Senate 24 Senate 25 Senate 26 Senate 27 Senate 28 Senate 29 Senate 30 Senate 31 Senate 32 Senate 33 Senate 34 Senate 35 Senate 36 Senate 37 Senate 38 Senate 39 Senate 40 Senate 41 Senate 42 Senate 43 Senate 44 Senate 45 Senate 46 Senate 47 Senate 48 Senate 49 Senate 50 Senate 51 Senate 52 Senate 53 Senate 54 Senate 55 Senate 56 Senate 57 Senate 58 Senate 59 Senate 60 Senate 61 Senate 62 Senate 63 Senate 64 Senate 65 Senate 66 Senate 67 Senate House "A" districts that you will screen 01A House 02A House 03A House 04A House 05A House 06A House 07A House 08A House 09A House 10A House 11A House 12A House 13A House 14A House 15A House 16A House 17A House 18A House 19A House 20A House 21A House 22A House 23A House 24A House 25A House 26A House 27A House 28A House 29A House 30A House 31A House 32A House 33A House 34A House 35A House 36A House 37A House 38A House 39A House 40A House 41A House 42A House 43A House 44A House 45A House 46A House 47A House 48A House 49A House 50A House 51A House 52A House 53A House 54A House 55A House 56A House 57A House 58A House 59A House 60A House 61A House 62A House 63A House 64A House 65A House 66A House 67A House House "B" districts that you will screen 01B House 02B House 03B House 04B House 05B House 06B House 07B House 08B House 09B House 10B House 11B House 12B House 13B House 14B House 15B House 16B House 17B House 18B House 19B House 20B House 21B House 22B House 23B House 24B House 25B House 26B House 27B House 28B House 29B House 30B House 31B House 32B House 33B House 34B House 35B House 36B House 37B House 38B House 39B House 40B House 41B House 42B House 43B House 44B House 45B House 46B House 47B House 48B House 49B House 50B House 51B House 52B House 53B House 54B House 55B House 56B House 57B House 58B House 59B House 60B House 61B House 62B House 63B House 64B House 65B House 66B House 67B House
