RISE TOGETHER: Story Form
Rise Together is a movement to engage California communities in the fight for equity and justice for our environment. The only way to protect the health of our communities is to engage and mobilize toward a clean future for ourselves and our children. We must Rise Together to create a healthier California for everyone, present and future.
Full Name
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Email Address
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Phone Number
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Address
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Organization
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Race/ Ethnicity
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Gender
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Age
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Languages Spoken
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What are your biggest concerns about the environment? Do you feel personally impacted by air pollution?
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Do you or any of your immediate family members suffer from conditions related to air pollution (asthma, heart disease, headaches)?
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Have you had to go to the doctor for health issues related to poor environment? Have you ever had to take off from work or school for environmentally related health problems for yourself or a family member?
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What would you say to lawmakers about the environmental issues facing your community?
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Are you willing to? (Check all that apply)
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