ActionDignity's Response to COVID-19

Question Title

* 1. You are answering this survey as:

Member of an organization

Member of a small group

Individual community member

Question Title

* 2. If you are a member of an organization or group, what is the name of your organization or group?

Organization or Group Name

Organization Contact Email

What is your name? (Optional)

What is your contact information? (Optional)

Question Title

* 3. What is your age group?

Under 16

16-25

26-49

50-65

Over 65