6700-029 Climate Champion Monthly Reflection

OMB Control Number: 2030-0051

Expiration Date: 05/31/2024

This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2030-0051). Responses to this collection of information are voluntary. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The public reporting and recordkeeping burden for this collection of information is estimated to range from 1 – 5 minutes per response. Send comments on the Agency’s need for this information, the accuracy of the provided burden estimates and any suggested methods for minimizing respondent burden to Director, Information Engagement Division, U.S. Environmental Protection Agency (2821T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.

Climate Champion Monthly Reflection

Please take a few minutes to reflect on your work as a Climate Champion this month. Your form submission will be viewed by CCSR's Climate Adaptation Team.

Project Reflections

Review your project goals and milestones.

1. What goals and milestones are you making good headway on?

2. Have any project goals changed or stalled? If yes, how so?

3. What was your highlight of being a Climate Champion this month?

4. What challenges to implementing your climate adaptation project have you faced this month? If none, write N/A.

5. Did you manage or work with any volunteers or students this month (for example, community members at workdays)? If so, how many do you think were there?

6. What was one thing about climate change you learned this month?

7. Please set 1-3 goals for yourself with respect to your Climate Champion work for the next month.

8. How can CCSR and/or your partner CBO better support you in your work going forward?

9. Please upload any pictures from your Climate Champions work this month.

Workshop Feedback

In this section, please share your thoughts about this month’s professional development workshop of: [insert workshop topic].

This event took place on [insert date] at [insert location]. The contact information for the speakers present at this event is: [NAME - EMAIL]

10. How satisfied were you with this workshop?

    • 1 – Very dissatisfied

    • 2

    • 3

    • 4

    • 5 – Very Satisfied

11. How would you rate the relevance of this workshop to your role as a Climate Champion?

    • 1 – Not relevant at all

    • 2

    • 3

    • 4

    • 5 – Very relevant

12. What, if anything, did you like about this workshop?

13. What, if anything, did you not like about the workshop?

14. Is there anything else you would like to add?

EPA Form: 6700-029