JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
June 2015 Constituent Survey
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Will agriculture in the urban classrooms improve student performance and reduce dropout rates?
Yes
No
Undecided
Clear selection
Do you agree that the strong families of Western Ohio is what makes this the greatest place in the world to live, work, and rear a family?
Yes
No
Undecided
Clear selection
Do you believe Ohio should continue to improve the ability of entertainment sectors to grow when it can be tied to economic improvement in Ohio?
Yes
No
Undecided
Clear selection
Should we continue to reduce the income tax in Ohio?
Yes
No
Undecided
Clear selection
Please provide any other feedback on the issues in the news this month.
Your answer
First Name
*
Your answer
Middle Name/Initial
Your answer
Last Name
*
Your answer
Suffix
Your answer
Mailing Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
County
*
Choose
Auglaize
Shelby
Mercer
Darke
Other
Email Address
*
Your answer
Phone Number
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
