Chinese Community Questionnaire
The Tung Jung Association of NZ wish to urgently assess the needs of the Chinese community for when the COVID-19 disease invades our communities. Any information collected is private and will be shared to other Chinese Community Organisations in your region but not for any commercial purposes.
Email *
Your Name? *
Address including street number, suburb, city *
What year were you born?
Do you have poor mobility?
Clear selection
Do you have your own transport?
Clear selection
Will you potentially need help?
Clear selection
Your Own Best Contact Telephone Number?
Your Next of Kin Contact name? *
Your Next of Kin Contact Mobile Number? *
Would you like us to call you soon?
Clear selection
What language do you speak
Do you need to know more about the COVID-19 pandemic?
Clear selection
Will you need help getting food, flu vaccination, and medicines?
Clear selection
Do you belong or identify with a local Chinese Association? ( If other eg. Church, provide name)
Clear selection
Can you assist in this emergency?
A copy of your responses will be emailed to the address you provided.
Submit
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