Jr Public Opinion Surveyor Interest Form

Jr Public Opinion Surveyor

BRITE and Ventura County Public Health invite Simi Valley youth to conduct surveys about the effects of tobacco products in your community.
JR Surveyors will conduct and collect a combined total of at least 150 Public Opinion Surveys in the City of Simi Valley throughout the month of June.

All Surveyors will receive training on how to conduct these surveys.
Name

First NameLast Name
School Name
Grade level
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
What is the best way to contact you?
Please select a Zoom training session to attend
Could you participate in at least one Zoom training session and one in-person, public surveying event?
Do you have any other questions for us?
Should be Empty: