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* 1. The purpose of this survey is for Variety to gain an understanding of the hardship our families are facing in response to the global COVID-19 (coronavirus) pandemic. If you wish to assist us by completing the survey, your responses may be shared with media or for publicity reasons.

We will not share any names or information that will allow you to be identified.

Do you understand?

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* 2. Has your family experienced disruption from your day to day life as a result of COVID-19?

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* 3. Please share with us how you feel about each of the following in regard to the developing COVID-19 situation:

  Not concerned at all A little concerned Feeling okay Concerned Extremely concerned
The need for my family to self-isolate
Our ability to access essential groceries and supplies
Our ability to access medical and/or health related appointments and support for my child/children
Our school and/or childcare closing down
Our employment being impacted (eg loss of income, work from home etc)
The financial impact on our family (ability to pay bills, mortgage, medical expenses etc)
My child/children's physical wellbeing
My child/children's mental wellbeing

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* 4. Do you have any other concerns that you would like to share?

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* 5. Do you think the Government is doing enough in response to COVID-19 (coronavirus) to address the needs of families and people living with disability?

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* 6. Thinking about COVID-19, what practical support and resources does your family need in the weeks and months ahead?

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* 7. Full Name: (for internal use only)

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* 8. Email: (for internal use only)

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