Pandemic Relief Survey
Thank you for filling out ExtendPUA.org’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 Legal@ExtendPUA.org.
* Required
Name
Your answer
Email Address
Your answer
What state do you live in?
*
Choose
AL
AK
AR
AS
AZ
CA
CO
CT
DC
DE
FL
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
ME
MD
MI
MN
MP
MS
MO
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
How old are you?
*
Choose
<18
19-25
25-30
31-40
41-50
51-60
61-70
71-80
81-90
>91
Prefer Not To Say
What is your race?
*
Choose
White
Hispanic or Latino
Black or African American
Native American or American Indian
Asian / Pacific Islander
Multiracial
An option does not exist for my race (please specify below so we can add it)
Prefer Not to Answer
If we are missing your race please specify and we will add it.
Your answer
What gender do you identify with?
*
Choose
Male
Female
Non-binary
Genderfluid
Gender Non-Conforming
Genderqueer
Agender
Two Spirit
Prefer not to say
If we are missing your gender please specify and we will add it.
Your answer
Which major political party do you most identify with?
*
Choose
Democrat
Republican
Independent
Progressive
Libertarian
Other
None
Prefer Not To Say
What industry do you usually work in?
*
Choose
Administrative and support services
Agriculture
Amusement, Gambling, and Recreation Industry
Arts and Culture (NOT live events and entertainment)
Bars and Restaurants
Business Services
Construction
Education
Essential Services Worker (not hospital related)
Film & TV
Finance
Government
Hospitality
Information Technology
Legal
Live Events and Live Entertainment (Theatre, Concerts, etc)
Medical - Frontline COVID
Medical - non-COVID
Manufacturing
Retail
Technology
Travel
Other
What is your typical employment status?
*
Choose
Full Time Employee (W2)
Part Time Employee (W2)
Freelancer paid through W2s
Freelancer paid through 1099s
Mixed Income (W2s and 1099s)
Small Business Owner
Other
What is your Current Employment Status? (can check more than one)
*
Unemployed
Unemployed, but with a sporadic day or two of work (still collecting UI)
Underemployed (less HOURS than pre-pandemic, no longer collecting UI)
Underemployed (less PAY than pre-pandemic, no longer collecting UI)
Underemployed, collecting partial UI
Employed now, but was at some point unemployed due to the pandemic
Employed outside my usual industry or field due to the pandemic
Employed - Never Lost My Job
Self - Employed and Working at Normal Rates/Hours
Other
Required
If you have taken a job outside your usual field, is that change permanent or temporary?
Definitely Permanent
Likely Permanent
Hopefully Temporary
Definitely Temporary
I don't know
Not Applicable
Clear selection
Do you have children or others who rely on your income?
Choose
Yes
No
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