Graton Pesticides (GRAPE) Study: Interested Residents Intake Survey
Thank you for completing this intake survey.
Your responses will help us select residences that best meet our research criteria.
Email address *
Name *
Address *
Phone number *
I'm interested in participating in the GRAPE Research Project by placing an air monitoring band on my residence for 30 days and providing indoor and outdoor water samples. *
I'm interested in engaging with and supporting the Graton community and the GRAPE Research Project even if I don't live in Graton or if my residence is not selected for the study at this time. *
How deep is your well (in feet)? *
To the best of your knowledge, is your well hand-dug or drill-bored? *
How close is your residence to local agriculture? *
Comments or Questions
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy