Pandemic Relief Survey
Thank you for filling out’s survey.

We need to better understand our community so we can better serve your needs in our advocacy for pandemic relief, workers’ needs, and more. When we make new choices on what issues are most important, your collective voice will be offered a vote. Thank you for joining us.

You will be entered in a random drawing to win one of 8 $100 gift cards for completion of this survey. We know it's not much, but we wanted to offer something. The gift cards were generously donated by a partner organization.

Your privacy is of primary importance to us. You can fill out this survey anonymously (though anonymous responses are ineligible for the gift card drawing). If you do provide your name and contact info, any identifying information collected will be accessible only to ExtendPUA and Rescue Agreement (our developing parent organization for future projects - same team, different name). You email address will only be used to notify you if you've won and for direct communication from our organization. All other information gathered will be used as a collective survey of answers and de-identified from your name and email. A description of the selection protocol for the Gift Card giveaway can be obtained by emailing
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Email Address
What state do you live in? *
How old are you? *
What is your race? *
If we are missing your race please specify and we will add it.
What gender do you identify with? *
If we are missing your gender please specify and we will add it.
Which major political party do you most identify with? *
What industry do you usually work in? *
What is your typical employment status? *
What is your Current Employment Status?  (can check more than one) *
If you have taken a job outside your usual field, is that change permanent or temporary?
Clear selection
Do you have children or others who rely on your income?
Clear form
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