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IED Portal

An Official Pennsylvania Government Website

Department of Environmental Protection

DEP

Environmental Justice Outreach Self Enroll Form

Please complete this form if you would like to self-enroll for future outreach and engagement opportunities with the Office of Environmental Justice (OEJ).

First Name

**

Last Name

**

Phone Number

**

Email

***

Address

*

State

*

Zip Code

*

Social Media

*

Organization Information

Organization Name

*

Organization Address

*

Organization State

Organization Zip Code

*

Organization County

Organization Phone

*

Organization Email

*

Organization Website

*

Organization Social Media

*

EJ Outreach Area of Interest

General

Air Quality

Mining

Oil and Gas

Radiation and Remediation

Waste

Water Quality

Other (specify)

Outreach Area of Interest Other (specify)

*

Organization Type

Community

Non-Profit

Religious Organization

Task Force

Other (specify)

Organization Type Other (specify)

*

Area of Coverage

Indigenous Lands

Municipality

Nationwide

Neighborhood(s)

Regional

State

Other (specify)

Area of Coverage Other (specify)

*

Additional Comments

Include any additional clarifications not covered in the preceding details within the form, such as language, interpretation, or translation, etc.

*

May PADEP contact you about this submission?

*

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