Member Feedback Douglas County Citizen's Coalition Question Title * 1. Have you previously attended any meetings held by Douglas County Citizen's Coalition? Yes No Question Title * 2. Have you participated in any of the action items suggested by Douglas County Citizen's Coalition? I have attended School Board meetings suggested I have signed/mailed letters suggested I have participated in other action items I need help to participate in action items I have not participated in action items I do not wish to participate in action items I would participate in other action items, please explain: Question Title * 3. What are your area of interest, you can choose more than one. Medical Freedom Election Education, Information, etc. Legislation Education, Information, etc. Covid-19 Mandates Prevention, Treatment, Alternatives Emergency Preparedness PMA's (Private Membership Associations) Children's Education Other (please specify) None of the above Question Title * 4. What School District do you reside in? Roseburg Camas Valley Days Creek Elkton Glendale Glide North Douglas Reedsport Riddle South Umpqua Sutherlin Winston-Dillard Yoncalla Other (please specify) Question Title * 5. Do you have children currently enrolled in Public School? Enrolled in-person or online Enrolled in-person or online AND looking for alternatives Home Schooled Not Enrolled Not Enrolled AND looking for alternatives No school age children in my home Other (please specify) Question Title * 6. Would you be interested in being listed in a walking bloodbank? Yes No Unsure What is a walking bloodbank!? Question Title * 7. Do you have a personal story or experience you would like to share? Yes. (Please email dccitizenscoalition@gmail.com or call 541-671-5035) No I'm not ready to share. Question Title * 8. What methods do you prefer, when receiving information? 1 - Most preferred method 2 3 4 5 - Least Preferred method Email Email 1 - Most preferred method Email 2 Email 3 Email 4 Email 5 - Least Preferred method Text Text 1 - Most preferred method Text 2 Text 3 Text 4 Text 5 - Least Preferred method In person In person 1 - Most preferred method In person 2 In person 3 In person 4 In person 5 - Least Preferred method Facebook Facebook 1 - Most preferred method Facebook 2 Facebook 3 Facebook 4 Facebook 5 - Least Preferred method Twitter Twitter 1 - Most preferred method Twitter 2 Twitter 3 Twitter 4 Twitter 5 - Least Preferred method Telegram Telegram 1 - Most preferred method Telegram 2 Telegram 3 Telegram 4 Telegram 5 - Least Preferred method Question Title * 9. How often are you available to attend in person meetings? Once a week Once a month Twice monthly I am unable to attend in person meetings I am not interested in attending in person meetings Question Title * 10. For in person meetings, what day of the week works best for you? Monday Tuesday Wednesday Thursday Friday Saturday Question Title * 11. For in person meetings, what start time works best for you? 12:00(noon) 1:00pm 2:00pm 3:00pm 4:00pm 4:30pm 5:00pm 5:30pm 6:00pm 6:30pm 7:00pm Other (please specify) Question Title * 12. If we held an in person meet and greet in the future, would you be interested in attending? Yes No Not Sure Question Title * 13. Please enter any comments, ideas, or suggestions you have for Douglas County Citizen's Coalition. Regarding meetings, website, agenda items, anything. Question Title * 14. If you wish to share your contact information with us, please do so here. This area can be left blank. Name Address Address 2 City/Town ZIP/Postal Code Email Address Phone Number Done
