WNC COVID Vaccine Listening Sessions
Thank you for your interest in participating in a 75-minute (one hour and 15 minutes) group listening session where we can hear learn more about your thoughts, questions and concerns related to COVID-19 vaccines.

IMPORTANT:
TO PARTICIPATE IN THE LISTENING SESSION YOU MUST EITHER:
---have just gotten your first vaccination in the past TWO Months (around the first of August)
OR
--be a parent who is having difficulty deciding on whether to vaccine your child.

If you participate, you will be take part in a conversation with people who are similar to you.  For example, you may be in a group of all young adults, or all parents.  The questions below will allow us to place you in the correct group.  They will also allow us to get in touch with you about the details of your Listening Session.

Here are some more details:

- Listening sessions will take place online. You will need access to a phone or computer with internet connection.

- Listening sessions will take place in October. You will receive an email invite.

- Your feedback will remain anonymous and will help inform our regional COVID-19 communications strategies and messages.

- You will receive  $30 for your participation. At the end of the listening session you will be asked whether you would like to receive a check or Visa gift card.

To learn more about our regional COVID-19 communications campaign, please visit www.wnchn.org/myreasonwnc.
Email adrienne.ammerman@wnchn.org with questions.

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What is your name (just your first name and first letter of your last name)?
Example: Jane D. or Juan B.
What is your racial/ethnic identity?
What county do you live in?  
What was the month when you got your first COVID-19 vaccine?
Please remember, if you are NOT a parent who is deciding whether to vaccinate their child, you MUST HAVE GOTTEN YOUR FIRST VACCINATION IN THE PAST TWO MONTHS.
Do you have children 12+ who are vaccinated?
Clear selection
Do you have children 5-11 who you are considering getting vaccinated?
Clear selection
What is the best time of day for you to participate in a virtual listening session (75 minutes)? Please check all that apply.
What is the best day of the week for you to participate in a virtual listening session (75 minutes)? Please check all that apply.
What is your email address?
We will email you details about your  listening session.
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