What pandemic-related issues are most important to you right now? *
Required
Can we share your responses anonymously? *
What's your name and contact information? (We will use this to reach out to you, but it won't be shared with anyone else.) *
Your answer
What city and state are you located in? *
Your answer
Thank you!
Someone from Senior and Disability Action might contact you about getting involved. Your responses will not be shared publicly unless you stated that they could be shared anonymously.