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COVID-19 Community Impact Survey

Demographics

This section will ask about some questions about yourself and members of your household.
This question requires a valid number format.
2. How many people - adults and children - currently live with you, including yourself? 
This question requires a valid number format.
3. Are you a caretaker of an adult(s) with special needs in your household?
3. Are you a parent / guardian of a child or youth with special health care needs?
 
We define children and youth with special health care needs as those who:
  • Have a chronic physical, developmental, behavioral or emotional condition that has lasted or will last 12 months or longer, and
  • Need health and other services beyond what is generally required by children.
3. Please select all that apply to you.
 
4. Were you pregnant during the COVID-19 outbreak or did you give birth since February 2020?
4. When did you give birth?
4. After the start of the COVID-19 outbreak, did your birth plans change?
4. What is the highest grade or year of school you have finished? 
5. In 2019, what was your total annual household income before taxes?
6. Have you ever been sentenced to stay overnight or longer in any type of corrections institution? Examples include a jail or prison.
7. What is your sexual orientation?
8. What is your current gender identity?
9. Are you transgender or of transgender experience? 
10. Are you Hispanic or Latino? 
11. What is your race? Select all that apply.
12. What is your ethnicity? Select all that apply.
13. Do you speak language(s) other than English at home? 
13. How well do you speak English?
English