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CLIMATE ACTION PLAN - City of Urbana

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4.4 APPENDIX D: PUBLIC INPUT FORMS<br />

9. List three (3) things that would assist you, or your organization, in reducing your greenhouse<br />

gas emissions.<br />

_________________________________________________________________________________<br />

_________________________________________________________________________________<br />

_________________________________________________________________________________<br />

_________________________________________________________________________________<br />

_________________________________________________________________________________<br />

_________________________________________________________________________________<br />

10. Are there any specific barriers that prevent you from utilizing these things described above If<br />

so, please specify. ___No ___Yes<br />

_________________________________________________________________________________<br />

_________________________________________________________________________________<br />

_________________________________________________________________________________<br />

_________________________________________________________________________________<br />

11. What programs or projects would you like to be pursued as part <strong>of</strong> the community-wide<br />

<strong>Urbana</strong> Climate Action Plan<br />

_________________________________________________________________________________<br />

_________________________________________________________________________________<br />

_________________________________________________________________________________<br />

_________________________________________________________________________________<br />

_________________________________________________________________________________<br />

_________________________________________________________________________________<br />

12. Please share any additional input or comments.<br />

13. Contact Information (optional):<br />

Name: ________________________________________<br />

Email: ________________________________________<br />

Mailing Address: _______________________________<br />

Phone: ________________________<br />

<strong>City</strong>, State: _____________________<br />

Check here to receive announcements about other <strong>Urbana</strong> Climate Action Plan and<br />

Sustainability efforts (provide contact information above)<br />

Check here to receive Sustainability Advisory Commission meeting agendas through<br />

e-mail (provide your email address above)<br />

Return this survey to:<br />

Anna Hochhalter, Community Development Associate/Public Arts Coordinator<br />

Community Development Services, <strong>City</strong> <strong>of</strong> <strong>Urbana</strong><br />

400 S. Vine Street, <strong>Urbana</strong>, IL 61801<br />

Phone: (217) 384-2311, or Fax: (217) 384-0200<br />

Email: alhochhalter@city.urbana.il.us<br />

2<br />

<strong>City</strong> <strong>of</strong> <strong>Urbana</strong><br />

83

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