Finding Community Amid Coronavirus
April 29 - 4:00-5:30 p.m.
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1.
Name
(Required.)
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2.
Email
(Required.)
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3.
I am a
(Required.)
Student
Community Member
Other (please specify)
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4.
Age Group
(Required.)
17-24
25-34
35-44
45-54
55-64
65-74
75+
Prefer not to answer
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5.
Gender
(Required.)
Female
Male
Prefer not to answer
Other (please specify)
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6.
Race/Ethnicity
(Required.)
White or Caucasian
Black or African American
Hispanic or Latino
Asian or Asian American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Prefer not to answer
Other (please specify)