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11th District COVID-19 Survey
From the office of State Representative Steve Bergquist
1.
When available, do you intend to get vaccinated for COVID-19?
Yes
No
2.
If you are currently eligible to receive the COVID-19 vaccine and have not received one yet, have you had issues finding a provider or scheduling an appointment?
Yes
No
N/A
3.
Do you have a child attending school remotely?
Yes
No
4.
If your child is currently attending remote schooling, would you prefer your child to attend in-person school?
Yes
No
N/A
5.
Are you or your family experiencing housing instability?
Yes
No
6.
Are you or your family experiencing food insecurity?
Yes
No
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)
