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