Welcome! COVID-19 Survey 1. What is your name?(Required) First Last 2. Who is your IL Coordinator?(Required) Deon Wendy Jhilma Janine Vanessa Clementine Danetta Craig Unsure 3. What is your age?(Required)4. When was your most recent exposure to COVID-19? Please give us a year.(Required)If you have not been exposed, type N/A.5. How many times have you had COVID-19?(Required)6. What services are you in need of? Please select one of the following.(Required) Medical Housing Transportation Employment Other 7. Has your need for services been...Please select one of the following(Required) Urgent Temporary Long-term Still in need 8. Has your health decline after COVID-19? If yes, please explain. If not, type no.(Required)
