Community Ascertainment Form - Community Problems, Concerns, Issues

In order to better understand the needs and concerns of Syracuse and the Central New York area, WSYT-TV and WNYS-TV have developed the following survey. The results of this survey will be incorporated into the FCC required Quarterly Report of Issues and Concerns and are used to direct our programming responsibilities.

We appreciate your time and thank you for sharing your concerns. All information obtained by this form will be kept confidential.

Name:		Race:	White African American Native American Hispanic Asian Other
Street Address:		Sex:	Male Female
City:		Email:
State:		ZIP:
Age:

Organizations/Groups in community in which Interviewee is active:

Single most important problem currently facing community:

Other problems in community which need attention:

Most important State Problem or need:

Most Important National Problem or need:

Captcha:

	Retype

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(Please only hit the submit button once.)