Survey : Questions

	Please complete and submit this online survey by April 10, 2012 to receive your collectable glow- in-the-dark patch! Please complete one survey per troop or family. Girls under 14, please complete with a parent or guardian!

1.	Name:
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2.	Troop #:
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3.	Email Address (parent or troop leader):
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4.	Number of girls participating:
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5.

Girl Scout Level (for multi-level troops, please select all that apply):

Dasiy

Brownie

Junior

Cadette

Senior

Ambassador

6.

Local Service Center:

Antelope Valley/Lancaster

Arcadia

Long Beach

Marina del Rey

Montclair

Santa Clarita

Woodland Hills

7.	What did you discover about energy and energy conservation?
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8.	Who did you connect with? How and when did you connect with them? What was their response?
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9.	What did you do to conserve energy?
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10.

Which Discover item did you complete?

Discover your carbon footprint

Find the difference between a renewable and a non-renewable energy source

Find the different ways your city, town, or county supports energy conservation

Find out how much trash the average household produces daily. How much of that is recyclable

Where does our recycled trash go? What does it become

11.

Which Connect item did you complete?

Contact your local government representative and tell them that you're a Girl Scout who cares about energy conservation

Connect with local Departments of Water and Power and ask them about their Sustainability Plan

Get a local school, church, or business to participate in Earth Hour, and to promote it to the public

Visit your local recycling center and learn about all the different materials they recycle

Learn what "E-waste" is, and find out where it can be recycled in your neighborhood

12.

Which Take Action item did you complete?

Have an "Earth Hour" campout in your backyard

Have a candlelight picnic with friends or family

Check for drafts in your house. Make your own draft stopper and install it

The Five-minute shower challenge

Visit your local hardware store and learn about simple ways to conserve energy

13.

Had you heard of "Earth Hour" before this program?

Yes

No

14.

Would you like to participate again next year?

Yes

No

15.

What other kinds of "eco-action" are important to you? (Please choose as many as you want.)

Reducing Waste

Saving Water

Planting Trees

Electricity Conservation

Protecting Endangered Species

Other

16.	What else can you do to help the earth?
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