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SURVEY FORM

PERSONAL INFORMATION

First name:

Last name:

GENDER
Female
Male

Birthday:

Nationality:

Interests (optional):
Music
Entertainment
Sports
Fashion
Science and Technology
Religion
Games
Cartoons
Nature
Medecine
Food
Others:

QUESTIONS:

Do you care about the environment?
Yes
No

Are you doing anything to help our environment?
Yes
No

If yes, what do you do?

Do you recycle or segregate?
Yes
Sometimes
No

Do you correct others when they don't segregate?
Yes
No

Do you minimize use of harmful objects to the environment?
Yes
No

As a committed citizen, what can you do to help save our environment?

Comments:

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created by :
NiCoLe SuN ::

Earth Friendly sites:
www.earth.com
www.environment.com
www.cleanandgreen.com
www.planetearth.com