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* 1. What is your first and last name?

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* 2. What is your email address?

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* 3. What is your phone number?

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* 4. What field do you work in?

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* 5. Are you a University of Utah employee?

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* 6. What is your position?

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* 7. Have you received the COVID19 Vaccine?

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* 8. What is your age range?

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* 9. What is your gender?

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* 10. What race or ethnicity do you consider yourself?

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* 11. Do you work with the public (at least 3 feet, e.g. co-workers, customers etc.)?

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* 12. Do you work at least 20 hours a week?

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* 13. Are you currently participating in any other COVID-19 studies?

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* 14. Do you speak English?

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* 15. Do you plan on relocating out of State within the next 12 months?

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* 16. Where did you hear about the study?

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* 17. You receive up to $50 in referrals. Please send us contacts you think maybe interested:

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* 18. Thank you so much for your interest in our RECOVER Study. Any questions can be directed to RECOVER@utah.edu. If you are eligible, you will be contacted shortly about enrolling in the study. Thank you so much for your time and support!

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