11th District 2022 COVID-19 Survey

From the office of State Representative Steve Bergquist

Question Title

* 1. Have you had issues getting in-person COVID-19 testing?

Yes

No

Question Title

* 2. Have you had issues getting at-home COVID-19 tests?

Yes

No

Question Title

* 3. Have you gotten a COVID-19 vaccine booster shot?

Yes

No

Question Title

* 4. If you have a school-age child, what environment are they learning in?

Public school

Private school

Homeschool

Alternative Learning Experience program

N/A

Other (please specify)

Question Title

* 5. If you have a child, have you had trouble finding child care?

Yes

No

N/A

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* 6. Are you or your family having trouble covering housing expenses?

Yes

No

Question Title

* 7. Your responses are anonymous, so if you'd like a personal reply:
a. Send me an email; or
b. Leave your name and phone number (optional)