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 address *
Your Name? *
Your answer
Address including street number, suburb, city *
Your answer
What year were you born?
Your answer
Do you have poor mobility?
Do you have your own transport?
Will you potentially need help?
Your Own Best Contact Telephone Number?
Your answer
Your Next of Kin Contact name? *
Your answer
Your Next of Kin Contact Mobile Number? *
Your answer
Would you like us to call you soon?
What language do you speak
Do you need to know more about the COVID-19 pandemic?
Will you need help getting food, flu vaccination, and medicines?
Do you belong or identify with a local Chinese Association? ( If other eg. Church, provide name)
Can you assist in this emergency?
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Tung Jung Association of New Zealand Inc. Report Abuse