Name of Community (required)
Address (required)
City, State and Zip Code (required)
Contact Name (required)
Your Email (required)
Phone (required)
Website Address (required)
Public Housing (required) YesNo
Affordable Housing (required) YesNo
Market Rate (required) YesNo
Single Family Home (required) YesNo
Other
Number of Smoke free Units (required)
Number of Smoke free Buildings (required)
Restrictions on smoking on premises (required) YesNo
Details of the smoking policy no smoking within distance from building, does the policy including vaping and electronic cigarettes?, etc
Policy effective date (required)