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This form only accepts US addresses.

Are you currently employed?

If multiple employers and one is a state contractor, list the state contractor. If self-employed, provide Name of Business. (Example: Dave's Painting. Other Examples: Retired, Unemployed, Student, Homemaker)

Age*
Are you a communicator lobbyist OR the spouse or dependent child of a communicator lobbyist?*
Are you a communicator lobbyist OR the spouse or dependent child of a communicator lobbyist?*
Are you a principal of a state contractor or a prospective state contractor?*
Are you a principal of a holder of a valid prequalification issued by the Connecticut Commissioner of Administrative Services?*
In addition to my contribution, I would like to be a volunteer for Nick Simmons for Senate:
  • I certify that I am NOT a principal of a state contractor or prospective state contractor.
  • I certify that I am either a United States citizen or a foreign national with permanent resident status in the United States.
  • I certify that I have provided my residential address.
  • I certify that this contribution is being made on my personal debit or credit card for which I have legal obligation to pay and intend to pay from my own personal funds, is not being reimbursed in any manner, is not being made as a loan, and is not an otherwise prohibited contribution and that payment is not made from the funds of a corporation, labor organization, or any other entity.
  • I hereby certify that all information disclosed by me on this contributor form is true and accurate to the best of my knowledge and belief.


Please find legal definitions here