* 1. What environmental issues are of concern in your community? Please clearly state the issues and describe impacts in your community.

* 2. If you are taking action on any of the issues listed above, please let us know what you're doing below.

* 3. Would you like assistance from the NAACP Climate Justice Initiative Technical Assistance Program? If so, what kind of assistance would you like?

* 4. Please share any other comments or questions here.

* 5. Please enter your contact information below.

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