Question Title

* 1. The West Virginia Board of Nursing has been asked by the State of West Virginia's Joint Interagency Task Force for COVID Vaccine to send this survey to you to ensure that you are on the list of healthcare professionals and staff to be vaccinated in West Virginia.  More information will be forthcoming regarding vaccine distribution.  Please enter the information requested below in order for you to receive next steps and further information on how and where you will receive your vaccine.  Please complete a separate survey for each member of your staff that wishes to get the COVID-19 vaccine.  Please enter the information indicated below for each person that wants the vaccine.

First name

Question Title

* 2. Last name

Question Title

* 3. Email address

Question Title

* 4. Postal code

Question Title

* 5. Age

Question Title

* 6. Organization Name

Question Title

* 7. WV county which you wish to receive the vaccine

0 of 7 answered
 

T