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* 1. What is your gender?

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* 2. What is your age?

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* 3. What is the highest level of school you have completed or the highest degree you have received?

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* 4. Which of the following categories best describes your employment status?

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* 5. How much total combined money did all members of your HOUSEHOLD earn last year?

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* 6. Are you White, Black or African-American, American Indian or Alaskan Native, Asian, Native Hawaiian or other Pacific islander, or some other race?

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* 7. Are you Mexican, Mexican-American, Chicano, Puerto Rican, Cuban, Cuban-American, or some other Spanish, Hispanic, or Latino group?

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* 8. Have you received the vaccine?

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* 9. How interested are you in receiving the vaccine?

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* 10. What were your concerns about the vaccine?

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* 11. How would you rate your experience receiving the vaccine?

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* 12. What is your vaccine story?

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* 13. Are you still wearing masks and social distancing?

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