Help us learn more about asthma in Newark.
Asthma is an epidemic in Newark. One in every four Newark children has asthma -- three times higher than the national average. And while asthma-related deaths are rare nationwide, Newark has experienced on average a death a year from 2010 to 2017, according to the New Jersey Department of Health.

The illness has a direct impact on students and schools, as we chronicled in recent stories. We'd like to hear from you. Are you a parent, student or educator in Newark dealing with asthma?

We will not publish any information we collect from you without your permission. We do ask for contact information so we can follow up. If you have any questions, email newark.tips@chalkbeat.org.
How are you connected to Newark schools? *
Tell us a little bit about how asthma has impacted your life. *
What should Newark schools do differently with regard to asthma? Are Newark schools doing anything well with regard to asthma that we should know about? *
Is there anything else we should know?
What is your name? *
We won't publish any information here without following up with you directly.
What's your email address? *
What is your phone number? *
Would you like to sign up for Chalkbeat Newark's free newsletter? *
Submit
Never submit passwords through Google Forms.
GoogleForms
This form was created inside of Chalkbeat.