Free Climate Change Impact Assessment Form

Please fill out this form to help assess how climate change impacts your life and community.
Personal Information
Name
Location
What changes have you noticed in your area over the past 5-10 years that you think may be related to climate change?
{Select all that apply)
Increased temperatures
Changes in rainfall patterns
More frequent severe weather events
How has climate change impacted your daily life??
(Select all that apply)
Health issues
Property damage
Increased costs
Changes in local food or water availability
In what ways have you observed climate change affecting your community?
(Select all that apply)
Loss of natural habitats or wildlife
Economic changes
Infrastructure challenges
Community health concerns
How concerned are you about climate change, and why do you feel this way?
Please share any additional thoughts or experiences related to climate change

Thank you for sharing your experiences and insights!
We appreciate you taking the time to submit.
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