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    Community Profile: Excellent Good Fair Poor 4 3 2 1 4 3 2 1

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    Marinella Aliazas Pineda
    This document is a sample community survey form aimed at gathering information to assist with environmental awareness in a community. It contains questions that rate the attitudes, commitment, and participation of local government personnel and citizens toward the environment on issues like waste management, conservation, and anti-smoking policies. It also asks if the community currently has an environmental program and its details. The survey is sponsored by a civic training program and aims to be used strictly for academic purposes.

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    Community Profile: Excellent Good Fair Poor 4 3 2 1 4 3 2 1

    Uploaded by

    Marinella Aliazas Pineda
    28 views1 page
    This document is a sample community survey form aimed at gathering information to assist with environmental awareness in a community. It contains questions that rate the attitudes, commitment, and participation of local government personnel and citizens toward the environment on issues like waste management, conservation, and anti-smoking policies. It also asks if the community currently has an environmental program and its details. The survey is sponsored by a civic training program and aims to be used strictly for academic purposes.

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    STI

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    This document is a sample community survey form aimed at gathering information to assist with environmental awareness in a community. It contains questions that rate the attitudes, commitment, and participation of local government personnel and citizens toward the environment on issues like waste management, conservation, and anti-smoking policies. It also asks if the community currently has an environmental program and its details. The survey is sponsored by a civic training program and aims to be used strictly for academic purposes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    28 views1 page

    Community Profile: Excellent Good Fair Poor 4 3 2 1 4 3 2 1

    Uploaded by

    Marinella Aliazas Pineda
    This document is a sample community survey form aimed at gathering information to assist with environmental awareness in a community. It contains questions that rate the attitudes, commitment, and participation of local government personnel and citizens toward the environment on issues like waste management, conservation, and anti-smoking policies. It also asks if the community currently has an environmental program and its details. The survey is sponsored by a civic training program and aims to be used strictly for academic purposes.

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    GE1801

    COMMUNITY PROFILE II. Environmental Awareness


    How would you rate the attitudes of the following towards the environment?
    Community Name: Purpose: Excellent Good Fair Poor
    Gather information to assist in Local Government Personnel 4 3 2 1
    environmental awareness within Citizens 4 3 2 1
    the community.
    Instructions: Please complete all relevant information below, as
    applicable. III. Environmental Commitment
    Date Created: Created By: How would you rate the commitment of the following towards the environment?
    Excellent Good Fair Poor
    Community Overview
    Local Government Personnel 4 3 2 1
    Community Type: Citizens 4 3 2 1
    Head of Council Name/Contact Number:
    Primary Contact Name/Contact Number: IV. Environmental Action
    Alternate Contact Name/Contact Number: How would you rate the level of participation of the following towards the
    Community Address: environment?
    Community Language/s (includes dialects): Excellent Good Fair Poor
    Population: Local Government Personnel 4 3 2 1
    Age and Sex Distribution: Citizens 4 3 2 1
    Age Group Male Female Total
    V. Environmental Practices
    How would you rate each of the following environmental practices in the
    community?
    Mode/s of Transportation to Access the Community:
    Excellent Good Fair Poor
    SAMPLE COMMUNITY SURVEY FORM
    I. Past Environmental Programs Waste segregation among local government
    4 3 2 1
    Does the community already have an environmental program? personnel and citizens
    Solid waste management 4 3 2 1
    Yes No Frequency of use of plastic products 4 3 2 1
    If yes, what is the name of this environmental program and what is it about? Reusing, reducing, recycling of wastes 4 3 2 1
    Energy and water conservation 4 3 2 1
    _______________________________________________________________ Anti-smoking policy 4 3 2 1

    Was the program a success?

    This survey is sponsored by the students of Civic Welfare Training Service


    1-Community Extension Program and will only be used strictly for academic
    purposes. To preserve your confidentiality please do not put your name on the
    survey. Kindly encircle the number that corresponds to your answer.

    02 Handout 4 *Property of STI


     student.feedback@sti.edu Page 1 of 1

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