1. Is this your first time filling out this survey?

2. Are you concerned about issues affecting the environment?

3. What environmental issue concerns you the most? Please describe only one issue.

4. Please rate your level of concern for each environmental issue:

  Not Concerned Somewhat Concerned Concerned Very Concerned
Drinking water
Air quality
Global warming
Destruction of natural environment
Food contamination by chemicals
Energy production
Clean rivers and springs

5. Please list any other environmental concerns not listed above:

6. Have you or someone in your household done any of the following to conserve water or preserve water quality?

  Yes No
Purchase/Use water-saving appliance(s)
Use car wash instead of washing at home
Lower water usage in the bathroom (i.e. shower)
Water the lawn less
Dispose of chemicals and oil through proper means

7. In your opinion, which of the following are most responsible
for the existing water pollution problems in rivers and lakes in your region?
Select all that apply.

8. Have you ever changed your mind about an environmental
issue as a result of:

9. Have you or others in your household ever participated in an environmental related activity such as a class, workshop, or volunteer work activity?

10. What is your preferred means to find out what is going on in your area?