COVID-19 Survey for Fourth Plain Community
(Aqui en Español: https://forms.gle/rUYZEcMehoQhQrLd8)

The Fourth Plain Coalition (http://fourthplainforward.org/fourth-plain-coalition/) is gathering information from renters in neighborhoods along Fourth Plain Boulevard in Central Vancouver about the impacts of the COVID-19 pandemic and needs within our community. This is an anonymous survey, it should take less than five minutes to complete.

Anyone who earns money to support your household can fill out the survey. Multiple people from the same household are allowed to fill out this survey.
1. Are you currently employed?
2. If you have recently lost your job, where are you getting income?
3. If you have lost your job, are you actively looking for employment?
4. For the items below, please select the level to which your household's need is being met. 1=none of your need being met to 5=all of your need being met. If an item does not pertain to you, please select "Does Not Apply".
1 - NONE of my need is being met
2 - SOME of my need is being met
3 - HALF of my need is being met
4 - MOST of my need is being met
5 - ALL of my need is being met
Does not apply
Stress/Emotional Support
Transportation
Accessing mental healthcare
Accessing healthcare
Obtaining food/water
Obtaining medications
Access to the internet
Access to the outdoors
Accessing childcare
Accessing information about COVID-19
5. What child care challenges are you experiencing due to COVID-19? (check all that apply)
6. After the eviction moratorium is lifted, are you able to pay your current and any back rent/mortgage? (check all that apply)
7. Is there anything else you would like to share about impacts of COVID-19 on your household or the Fourth Plain community?
Your answer
8. How many people currently live in your household, including yourself?
Your answer
9. Which one or more of the following describes your race? (check all that apply)
10. Are you Hispanic or Latino/a?
11. What is your zip code? (e.g. 98661) *
Your answer
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