COVID Vaccine
1.
Age? (Select one)
0-17
18-24
25-49
50-64
65+
2.
Race?
White
Hispanic
African-American
Asian
Native American
Other
3.
Gender?
Male
Female
4.
Zip Code?
27889
27865
27860
27808
27806
27821
27814
27817
27810
*
5.
Have you already received the COVID-19 vaccine?
(Required.)
Yes
No
Current Progress,
0 of 10 answered
