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* 1. Please indicate the North Idaho county in which you reside.

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* 2. Please indicate birth gender.

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* 3. On a scale of 1 to 5...

Please indicate the level of social interaction you were able to maintain while practicing social distancing.

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* 4. On a scale of 1 to 5...

Please indicate your ability to stay connected with family, friends, Fit and Fall Proof “buddies”, Senior Companion, etc., while “self-isolating” at home.

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* 5. On a scale of 1 to 5...

Please indicate how well your basic needs were met, i.e. food, healthcare, transportation, etc.

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* 6. Please indicate which of the following has provided the strongest support during the COVID Challenge? (Choose all the apply!)

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* 7. Please list anything specific that you feel could be done now and in the future to better support you, and the community at large, during times such as those we have been experiencing?

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* 8. Do you have any other comments, questions, or concerns?

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