Thank you for participating in this short 2-minute survey provided by the Health Department. Your answers will help us better reach members of your community and provide access and services to people who need them. The information you provide will be confidential. Please respond to this survey by Thursday, September 30, 2021.

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* 1. What is your age?

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* 2. What race/ethnicity do you identify with?

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* 3. Gender Identity: Choose the one that best describes you.

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* 4. What is the ZIP code where you reside?

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* 5. What is your COVID19 vaccination status?

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* 6. Where would you be most comfortable receiving your vaccine?

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* 7. Which of the following would motivate you to get vaccinated?

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* 8. What questions or concerns (if any) do you or your parents have about the vaccine?

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* 9. If you want a response to your question(s), please enter your email address.

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* 10. What social media apps do you regularly use?

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