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Survey COVID-19 UPDATE HCC SG
Indicates required field
II) What is your zip code area?
How many person(s) live in your household?
III) Email address
3) In the process of a change
V) What is your ethnicity?
2 Latino / Hispanic
5 Other: Two or more races
VI) Your age is between___?
7) Prefer not to say
VII) Your family income last year was between?
1) Prefer not to say
2) Less than $10,000
6) > $100,000
VIII) What is your current job status?
5) Housewife / husband
6) Full-time Student over 6 months
VIII) Have you been tested for the COVID-19?
VX) What was the highest level of educational course you last completed?
1) High School Level
2) Community - Trade College Level
3) Bachelors College Level
4) Masters Level Class
6) Doctoral Level Class
X) How often does your family save to have emergency crisis funds?
1) At least once per week for 6 months
2) Once per month for 12 months
3) About 2 to 3 months per year
4) Only one time in the year
5) You do not save
XI) When was the last time you visited a doctor?
1) Less than 5 days
2) Less than 6-9 weeks
3) Less than 6-12 months
4) Over a year
5) Over 5- 9 years
6) It has been to long to remember.
XII) What are the chance you or someone you know likely contact the COVID-19?
I) Highly likely
2) Somewhat likely
4) Least Likely
XIII) How did you hear about the questionnaire?
1) Internet Search
XIV) Please Specify: Who invited you, What school or how did you hear about the survey?
XV) Have you and your family been wearing face cover masks when you go out?
XVI) If you were tested positive for the COVID-19, what symbols did you have with the virus? enter NA if the question does not apply to you.
XVII) How are you feeling mentally? check all that are a concerny
1 having some anxiety
2 some what stressed
3 feeling depressed do not know how things will continue
5 Okay, Taking things day by day
XVIII) How satisfied are you with the way the federal government has handle the current crisis?
1. Very Satisfied
5. Very Unsatisfied
XIX) If possible: please share additional resources and tell us what you and others might need doing this COVID-19 crisis?
XX) Looking back on the last couple of crisis, how important do you think it would be for a family to try to save the 6 months recommended funds? Also considering, today times a family member could experience a lost of a jot, health issues or there could be another world crisis? Choose One
1. Very Important
4. Somewhat Important
5. Not at all Important
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