You are asked to complete this questionnaire because your professor integrated an environmental community project addressing either climate change or water quality into this course. Please take a few minutes to answer the following questions. Thanks!

On the left side, please indicate how confident you are in your ability to accomplish the following:

On the right side, please indicate how motivated you are to accomplish the following:

  
Name basic facts and statistics about environmental issues in my community
Name the causes of environmental degradation in my community
Identify a range of solutions to environmental issues in my community
Identify stakeholders who influence environmental issues in my community
Name specific environmental actions to take in my community
Educate others about environmental issues
Encourage others to get involved with environmental issues
Tackle environmental challenges in my community
Discourage others from engaging in environmentally-degrading activities
Use environmentally sustainable practices in my daily life
Sustain a lifelong commitment to environmental stewardship

If you have already completed the course, use the following field to indicate how your work on a community environmental project through this course has impacted you?

Please indicate your college or university:

Please provide the last name of the instructor of this course:

Please provide the course number of this course: (If you are unsure, ask your instructor.)

In the following field, please create a six-character ID string using the following algorithm:
- The first two characters should be the first two letters of the street that you grew up on.
- The third and fourth characters should be the first two digits of your phone number (not including area code).
- The fifth and sixth characters should be the first two letters of your mother's maiden name.

For example, if I grew up on Elm Street, my phone number is 555-1234, and my mother's maiden name is Jones, then my code would be EL55JO.

This system will allow us to identify you again when you take this survey again while retaining your anonymity.


ID string:

It is expected that you will take this survey twice, once at the beginning of your course and once at the end. Please indicate your current status:

I am at the beginning of my course.
I am at the end of my course.