Saint Gerard's Reuse Committee

2. Town relationship*

   Are you a Canton Resident, Business, or Non-Resident

   1. Resident
   2. Business
   3. Non-resident
3. Demographic Age Group*

   1. Less than 18
   2. 18 to 25
   3. 26 to 40
   4. 41 to 55
   5. 56 +
5. Would you like to take a tour of the facility

   1. Yes
   2. No

   If Yes, then please provide some contact information so we can contact you to schedule the tour

7. First Name
8. Last Name
10. Phone number
11. E-mail address
15. Highest need*
    -- Select One --Community CenterEducation Municipal UseRecreation / Open spaceSenior / Veteran HousingOther

    Please select one of the following that you feel is the highest need in the community

17. Please provide details for your first selection:
19. Are there any factors that the committee should consider related to your recommendation?
21. Second Highest need*
    -- Select One --Community CenterEducationMunicipal UseRecreation / Open spaceSenior / Veteran HousingOther

    Please select an item that you feel is the second highest need in the community

23. Please provide details for your second selection:
25. Are there any factors that the committee should consider related to your second recommendation?
27. Third Highest need
    -- Select One --Community CenterEducationMunicipal UseRecreation / Open spaceSenior / Veteran HousingOther

    Please select an item that you feel is the third highest need in the community

29. Please provide details for your third selection
31. Any factors that the committee should consider related to your third recommendation?
33. What would you not like to see at the site
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field