Washington Climate Assembly

Thank you for choosing to join the Washington Climate Assembly!

Your participation is essential to the success of this program, and we all want to THANK YOU for your willingness to support the democratic process through learning, sharing, and meeting and acting as one of our esteemed resident representatives.

Given it is hard to keep track of information in a phone call; we ask that you submit this form to verify your information as well as your ability to meet during the scheduled assembly sessions. Sessions will meet on TUESDAY EVENINGS from 6 pm to 8 pm and SATURDAY MORNINGS from 10 am to 1 pm via Zoom (a virtual meeting platform).

Currently; the Assembly Schedule is as follows:

Please take a moment and respond to the questions below so we can ensure the information we have for you is correct.

Responding via this form is REQUIRED so we have your personal verification of your intent to participate.

Washington Climate Assembly Affirmation Screener

• Session Schedule*
  As we discussed with you on the phone and outlined above, participating in the Climate Assembly includes participating in Learning Sessions, Meetings, and Deliberations with other representatives using Zoom. First, we want to confirm you are able to meet the schedule demands for this project:
  • Yes, I will be able to attend all Sessions as Scheduled
  • Yes, I will attend all Sessions, but I may have some conflicts
  • No, I cannot attend all Sessions and would like to withdraw my participation
• Name*
  First Last
• Email*
  Please enter the email you have with us.
  Enter Email Confirm Email
• What year were you born*
  Enter the year you were born, like 1999 or 1972.
  Please enter a number from 1900 to 2050.
• Gender*
  Which best describes the gender to which you most identify?
  MaleFemaleTransgender FemaleTransgender MaleGender Variant or Non-Conforming
• Which County*
  Which US County, Parish, or Township do you live in?
  -- SELECT BELOW --AdamsAsotinBentonChelanClallamClarkColumbiaCowlitzDouglasFerryFranklinGarfieldGrantGrays HarborIslandJeffersonKingKitsapKittitasKlickitatLewisLincolnMasonOkanoganPacificPend OreillePierceSan JuanSkagitSkamaniaSnohomishSpokaneStevensThurstonWahkiakumWalla WallaWhatcomWhitmanYakimaAnother county not listed
• Race/Ethnicity*
  What is your race or ethnicity? If you are mixed race, select all races you represent.
  • African American
  • Asian
  • Caucasian
  • Hispanic or Latino
  • Middle Eastern
  • Native American or Alaskan Native
  • Pacific Islander or Native Hawaiian
  • Some Other Race
• Education*
  Which best describes the highest level of education you have had the opportunity to complete?
  Some high schoolGEDHigh schoolSome college (no certificate)Associates degreeTechnical schoolBachelors degreeSome post graduatePost graduate degree
• Political Leaning*
  Typically do you consider yourself more of a Democrat, Republican or something else? Even if you don't vote, how do you think about public policy?
  Strong DemocratIndependent leaning DemocratIndependentIndependent leaning RepublicanStrong RepublicanLiberalModerateConservative
• Occupations*
  Do you work in, or have any training in any of the following industries or fields? Select all that apply
  Banking or Finance FieldsEducation FieldsGovernment FieldsHealth Insurance FieldsLaw Enforcement FieldsLegal FieldsMarketing and Communications FieldsMedical FieldsMental Health FieldsMilitary FieldsNews and Media FieldsNone of the above
• Elections Voting In*
  What Elections do you usually vote in?
  General Elections (usually held in November)Primary ElectionsLocal ElectionsSpecial ElectionsNot Registered or Do Not VoteNot Eligible to Vote
• Children at home
  Do you have any children under the age of 18 at home?
  • Yes
  • No
• Marital status*
  Which best represents your current marital status?
  -- SELECT BELOW --DivorcedLiving with PartnerMarriedSingleWidowed
• Household income*
  Which category best represents your family's total household income, before taxes annually?
  -- SELECT BELOW --Under $20K$20-$35K$35-$50K$50-$80K$80-$100K$100-$150K$150-$250K$250K or more
• Homeownership
  OwnRentI have a different arrangement
  Do you own or rent your primary residence?
• Employment Status*
  Which best describes your current employment status?
  -- SELECT BELOW --Full-timePart-timeSelf-EmployedHomemakerRetiredUnemployedStudentDisabled
• Climate Change Attitude*
  What is your attitude towards climate change? Would you say its......
  -- SELECT BELOW --AlarmedConcernedCautiousDisengagedDoubtfulDismissive
• Global Warming*
  For the following statement, please pick the answer below that best represents your feeling towards the statement: I believe global warming is happening.
  -- SELECT BELOW --YesI don't KnowNo
• Human Activitites*
  For the following statement, please pick the answer below that best represents your feeling towards the statement: I believe global warming is caused mostly by human activities.
  -- SELECT BELOW --YesI Don't KnowNo
• Worried about Global Warming*
  For the following statement, please pick the answer below that best represents your feeling towards the statement: I am worried about global warming.
  -- SELECT BELOW --YesNo
• Payment preference
  How would you like to receive your participation incentive? Digital payments are sent to the email address we have on file for you. We will verify this information with you again closer to the time we distribute payments, but for planning purposes, we'd like to know how you'd like to receive your $500 in March at the conclusion of the Assembly.
  AmazonCheckPayPalSquare CashVenmoZelle
• Address*
  Please enter your mailing address so we can mail you your study information in addition to the email information you will receive from us. Include your CITY, STATE, and ZIP CODE as well.
• Phone
  This field is for validation purposes and should be left unchanged.