Privacy and Feedback Form

Information provided in this survey is considered a public record and may be subject to public disclosure. For more information, see the Public Records Act, RCW Chapter 42.56. To learn more about how we manage your information, see our Privacy Statement at http://www.seattle.gov/privacy-statement.

Thank you for taking the first step to help improve the Adopt-a-Drain program! Below we ask that you fill out some information about yourself and then you will have the opportunity to provide Adopt-A-Drain Seattle some feedback on our current program.

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* 1. First and Last Name (Not Required):

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* 2. What neighborhood do you live in? (Not Required)

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* 3. Have you already signed-up online as an Adopt-A-Drain volunteer?

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* 4. What topic best describes your feedback for the Adopt-A-Drain program?

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* 5. What comments or feedback would you like to share with the Adopt-A-Drain program?

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* 6. How would you rate the overall current Adopt-a-Drain program?

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* 7. If you would like, please provide your email for a program staff member to address your feedback.

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