Phoenix Project: SUBJECT Submission Form
We appreciate your interest in being a subject for the documentary film The Phoenix Project.

The Phoenix Project is a documentary film project following the effects of the COVID-19 outbreak, and its impact on individuals across the globe. We’re looking for participants from all walks of life to help us tell their story via self-documentation and remote communication! If you’re interested in taking part, or know someone who might be, please fill out the form below and/or send it to friends and family.

By submitting this form you agree that the information provided was true to your knowledge and volunteered freely and willingly to the Phoenix Project. The submitter also understands that while the Project does review every submission, they will not be responding to every applicant.

Thank you for contributing towards our project!
Email address *
What is your name? *
Your answer
Best way to contact you? (Email, phone, etc.) *
Your answer
What is your phone number?
Your answer
Where are you currently located? *
Your answer
Marital Status? *
Do you live alone? *
Do you have children? *
Do you have access to a camera (webcam, cell phone, digital cinema camera)? *
Your answer
What is your largest concern in regards to the COVID-19 Pandemic? *
Your answer
What is your profession? *
Your answer
Are you currently employed? If not, were you unemployed due to the COVID-19 Pandemic and are you collecting unemployment? *
Your answer
Are you deemed an essential worker? *
Are you still commuting to work or are you working from home? *
How has your work been impacted by the COVID-19 Pandemic? *
Your answer
Has your future work been impacted by the COVID-19 Pandemic? If so, how has it been impacted? *
Your answer
On a scale from 1-10, are you worried about income? *
Least Worried
Most Worried
On a scale from 1-10, how has your productivity been impacted from the COVID-19 Pandemic? *
Not Impacted
Greatly Impacted
On a scale from 1-10, how comfortable are you discussing your mental health with the project? *
Not Comfortable
Very Comfortable
How have you been impacted mentally from the COVID-19 Pandemic? *
Your answer
Are you currently using any mental health resources (counseling, medication, etc.)? *
Were you using any mental health resources (counseling, medication, etc.) before the Pandemic? *
Are you a mental health professional? *
Are you a caregiver for an individual who requires mental health assistance? *
Are you experiencing any difficulty with caregiving? *
Is there anything else you'd like to tell us in regards to how you've been impacted by the COVID-19 Pandemic? *
Your answer
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