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* 1. What zip-code do you currently live in?

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* 2. How many people currently live in your household?

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* 3. Do you have any children currently living in your household?

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* 4. What is your gender?

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* 5. What is your age?

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* 6. What is your race?

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* 7. What/who do you trust the most to receive information related to coronavirus? (one or more options)

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* 8. What is the highest grade or year of school you completed?

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* 9. What is your current employment status?

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* 10. How concerned are you about paying for your rent/mortgage?

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* 11. How concerned are you about having enough food for yourself and your family?

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* 12. How concerned are you about having transportation?

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* 13. How concerned are you about being able to see a doctor?

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* 14. What is your primary concern for yourself and your family today?

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* 15. How are you taking care of yourself and being hopeful for the future of your community?

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* 16. What resources are you looking for and unable to find at this time in your community?

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* 17. Please list any other concerns or thoughts you may have:

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