What you think matters survey - Getting Vaccinated Matters - AHARI - A Home Is A Right

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WHAT YOU THINK MATTERS SURVEY

GETTING VACCINATED MATTERS SURVEY
BE ENTERED TO WIN A $50 GIFT CARD in our monthly giveaway!

AHARI - A Home Is A Right has launched its GETTING VACCINATED MATTERS campaign. We realize that for many reasons many are hesitant to get vaccinated and many of you who are vaccinated. We want to let you know, What You Think Matters. Take the two minute survey below and be entered to win a $50 Gift Card in our monthly drawing! We want to hear from you!

Been vaccinated? Enter the I GOT VACCINATED giveaway here for an opportunity to win $100!
Do you want to get vaccinated for free? Register here for our upcoming free COVID-19 Vaccine Clinics or if you can't make it, leave a message here. Please, include your zip code and contact information.

TAKE SURVEY NOW

Enter unique identifier for this survey (AHARI Staff Only). *

* Indicates required field

Please, provide your five digit zip code. *

How old are you? *

How many people live in your household including yourself? (check one) *

1 2 3 4 5 6 or more

Have you been fully vaccinated against COVID-19? (check one) *

Yes, I am fully vaccinated against COVID-19 No, but I have gotten 1 shot of the 2 needed, and I intend to get the second one soon. No, but I have gotten 1 shot of the 2 needed, however I DO NOT intend to get the second shot soon. No, I have not gotten COVID-19 vaccination, but I plan to No, I have not gotten COVID-19 vaccination, and I DO NOT intend to I prefer not to answer

If you have already had one or more shots of the COVID-19 vaccine, please indicate the vaccine you received *

I have not gotten COVID-19 vaccine I have had 1 or 2 shots of the Pfizer COVID-19 vaccine I have had 1 or 2 shots of the Moderna COVID-19 vaccine I got the Johnson & Johnson (Janssen) vaccine I got the COVID-19 vaccine, but I do not know which one I prefer not to answer

If you have not gotten the COVID-19 vaccine, please indicate additional information you want to better understand the vaccine and feel confident in getting vaccinated *

The cost to get a COVID-19 vaccine Where to get COVID-19 vaccine shots How does the vaccine protect you from getting COVID-19 Are the vaccines really safe? Can they give you COVID-19? Are the vaccine doses of COVID-19? Is the Johnson & Johnson COVID-19 vaccine safe? Do the vaccines work against other variants of COVID? I do not trust vaccines or I do not trust that we are not experimental subjects I prefer not to answer Other

How do you identify? (check all that apply) *

Male Female Transgender Gender queer, gender nonconforming, gender binary Agender Prefer not to say Other

How do you identify? (check all that apply) *

Black or African American White American Indian or Alaskan Native Asian Native American or Pacific Islander Prefer not to say

Do you identify as Hispanic or Latino/Latina/Latinx? *

Yes No I prefer not to answer

What is your martial status? *

Married In A Domestic Partnership Single Divorced Widow/Widower I prefer not to answer

Do you own your home? *

Yes No

Do you want us to text you if you win the Gift Card Drawing? *

Yes No

If yes, what is your mobile/text number? *

THANK YOU!

Your answers will be associated with a unique identifier number and not with any of your personal information. Thank you again for taking the time to take our survey!

Submit

Protect yourself. Protect your community. Get vaccinated.

A Home Is A Right (AHARI) is a 501 (c) (3) Non-Profit Organization

CONTACT

Email: [email protected]
P.O. Box 16651
Philadelphia, PA 19139

Copyright 2012 © AHARI - A Home Is A Right All rights reserved.

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