COVID-19 Vaccine "Dose Saver" Question Title * 1. I am eligible for vaccination as an individual in Phase: Phase 1a - Frontline Healthcare Worker (Hospital Setting/Non-hospital Healthcare/Long-term Care/Other Congregate Care) Phase 1b - Individuals aged 65 and over Phase 1b - First Responders (Fire/Law Enforcement/Emergency Communications/Security Personnel/School Officers) Phase 1b - Education (Congregate Child Care/Pre-K thru 12th Grade - Teachers/Principals/Student Support/Student Aids/Day Care Workers) Phase 1b - Food & Agriculture (Processing/Plants/Veterinary Health/Livestock Services/Animal Care) Phase 1b - Manufacturing (Industrial production of good for distribution to retail/Wholesale or other Manufacturers) Phase 1b - Corrections Workers (Prison-Jail Officers/Juvenile Facility Staff/Workers providing In-person Support) Phase 1b - United States Postal Service Workers Phase 1b - Public Transit Workers (Flight Crew/Bus Drivers/Train Conductors/Taxi Drivers/Para-Transit Drivers/In-person Support/Ride Sharing Services) Phase 1b - Grocery Store Workers (Baggers/Cashiers/Stockers/Pick-up/Customer Service Phase 1b - Shelters/Adult Day Care (Homeless Shelter/Women's Shelter/Adult Day/Drop-in Program/Sheltered Workshop/Psycho-social Rehab) Phase 1b - Plus Eligible Individual (Obesity/Diabetes/Pulmonary Diseases/Smoking/Heart Conditions/Chronic Kidney Disease/Cancer/Solid Organ Transplant/Sickle Cell Disease/Pregnancy/Persons with a Disability - not otherwise covered in previous categories) Phase 1b - Government Employee (Federal/State/Local/Municipal Government Employee not eligible under previous phases Phase 1b - Higher Education Staff (Workers in educational institutions, including junior colleges, four-year colleges and universities, technical schools, trade schools, educational support services, and administration of educational programs) Phase 1b - News Media (Newspaper, television, radio, and other media services) Phase 2 - General Population (18 years of age and older) OK Question Title * 2. Name OK Question Title * 3. 24/7 Contact Number - (Area Code) and Phone Number OK Question Title * 4. Email Address OK Question Title * 5. Date of Birth (Month, Day, Year) OK Question Title * 6. County of Residence Peoria Tazewell Woodford Other OK DONE