SHIP Policy Concerns & Impact Statements
Thank you for taking the time to review this form and write about how you and/or your friends, loved ones will be impacted by the university's SHIP plan changes. Your completion of this form is voluntary and your responses will be kept anonymous. Responses may be used in written statements in the Daily Cal or other outlets to speak out against the disproportionate impact that changes in the SHIP policy will have on already marginalized students.
What is your affiliation to UC Berkeley? *
Do you use SHIP for your health insurance? *
To what extent are you familiar with the changes in the SHIP contract? *
Do you have any dependents on your health insurance plan? (i.e. your child/children) *
Do you have a chronic illness or disability? *
In the last year, have you visited the emergency room to get care for yourself or dependent(s)? *
How will you (or your friends, loved ones) be impacted by the SHIP changes? Please share your concerns and reactions. *
Your answer
Would you like us to follow up with you for ongoing organizing efforts? If so, please provide your name and contact information below.
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of UC Berkeley. Report Abuse