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* 1. First and Last Name:

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* 2. Gender:

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* 3. Race/Ethnicity:

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* 4. Home Address:

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* 5. Email Address:

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* 6. Phone Number:

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* 7. Which of the following best describes your current employment status?

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* 8. Prior to March 1, 2020 when COVID-19 began spreading in the United States, which of the following best described your employment status?

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* 9. Which of the following do you need to be able to stay at home safely and practice self-isolation or quarantine? (Please select all that apply)

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* 10. Given your answer(s) to the previous question, do you know where to access the services you need?

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* 11. What has been your biggest challenge(s) caused by the COVID-19 Safer-At-Home Order?

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* 12. Davidson County currently has federal stimulus money to spend on COVID-19 response. How would you like to see those funds used? (check all that apply)

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* 13. Are you currently registered to vote in Davidson County?

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* 14. Have you completed the 2020 Census?

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* 15. How much of a say do you think you have in local government? 

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* 16. Why?

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* 17. Have you done any of the following activities over the past six months?

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* 18. Do you plan on voting in the upcoming 2020 General Election on November 3rd? 

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