The Green Scheme Community Survey

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Please complete this 5 minute survey to help our organizationlearn more about your opinions about your community and environment.

What year were you born? *

Which of the following best describes your race/ethnicity?

What is your gender?

What Ward or County do you live in? *

What is your E-mail Address?

(optional)

What do you think are the most important problems in your community?

Pick the top 3

Lack of Jobs/Unemployment

Safety/Violence

Pollution (air, water, litter)

Child Neglect/Abuse

Drug Abuse

Lack of access to Healthy Foods (fresh produce) / No healthy food options

Poor Housing Conditions

Pest

Lack of Quality Education/ Poor Public Schools

Lack of Health Care (good doctors/hospitals)

Other:

Do you think it really matters if your food is organic?

Organic foods are made in a way that limits the use of synthetic materials during production

Yes, I think there is a difference between organic and non-organic food

I am not sure

No, it doesn't really make a difference; organic food is the same as non-organic

Clear selection

Do you feel that pollution is impacting your health?

Pollution is the presence of chemicals or other materials found in the environment

Yes, I think pollution is affecting my health

No, I do not think that my health has been effected by pollution

I don't know

Clear selection

"Sometimes it is ok to toss trash on the ground because someone will eventually come to pick it up."

On a scale of 1 to 5 please rate how much you agree with the statement above

Strongly Disagree

Strongly Agree

Clear selection

Clear form

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