WIIN Enrollment Survey

Thank you for your interest in participating in the Free Lead testing in Drinking Water for Schools and Childcare Facilities Program. Use this form to enroll in the program. During this survey, we will ask you questions about your school type, water consumption, and building information. We will also ask you questions related to the socioeconomic and demographic information to help prioritize testing.

You must submit a form for each individual facility. If you would like to enroll more than 10 facilities, please contact us via email at waterscreening@azdhs.gov. For assistance completing this form, email us or call us at 602-364-3884.