LET'S HUDDLE CAMPAIGN

EDUCATE • ENGAGE • EMPOWER

Community Outreach Survey

Help us to assess the needs of our community! Please complete the survey below.
The survey takes approximately 5 minutes to complete.

As a recipient of the Alabama Department of Public Health COVID-19 Community Outreach Grant, we are responsible for recording key demographic information on the communities we serve.

This information will also provide us with valuable insights to help us better serve you and to ensure you and your family has access to high-quality COVID-19 related care and resources.

Will you help us by filling in a few questions?

We will not use your phone number to contact you unless you give us permission, via the next question.
By selecting "Yes" above, you agree to allow Dre Kirkpatrick's 21 Kids Foundation to send text messages to the number provided with surveys and other important COVID-19 resources and support updates.
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Select all that apply to account for each member of your household.
Select all that apply.
If you have been vaccinated or would like to in the future, select answers below to describe your motivation for this decision. If you have NOT been vaccinated and/or DO NOT plan to be in the future, select answers below to describe your motivation for this decision.
Selected Value: 5
Drag the slider to the appropriate value, where 1 is "I am extremely opposed to the COVID-19 Vaccine" and 10 is "I am extremely confident that the COVID-19 Vaccine is an effective solution."