Faces of Fracking – Story Collection Toolkit

Thank you for agreeing to submit a story to the Ohio Ecological Food and Farm Association (OEFFA) for display on the ‘Faces of Fracking’ webpage. The purpose of this webpage is to help connect the general public with the farmers, rural landowners and local food businesses that are at risk of the impacts of highvolume hydraulic fracturing. Below is a form for each participant to fill out. Please submit this form and any corresponding photos and/or videos (no more than two minutes) to mackenzie@oeffa.org. Thank you for your commitment to a healthy and sustainable food and farming system. Name:_______________________________ Farm/Business:__________________________________ Address:_________________________________________ City:__________________ State:________ Phone:_________________________ Email:_______________________________________________

1) Please provide a brief introduction to yourself.

2) Are you currently locked into a lease? OR have you been asked to sign a lease?

3) How long have you resided at your current address/owned your current business?

4) How is fracking impacting you and/or your community?

5) What are your major concerns surrounding fracking?

6) What would you like to see done about fracking?

By signing below, you agree to have your video and/or picture(s) published on the OEFFA website with a brief write-up compiled by an OEFFA staffer using your written response above. This information will be made available to the general public, media and to decision-makers.

SIGNATURE: ___________________________________________ DATE: ______________________
Please contact MacKenzie Bailey, OEFFA’s Policy Coordinator with any questions at: 614-421-2022 ext. 208 or mackenzie@oeffa.org

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